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There is nothing called Ethical Surrogacy

Surrogacy (Regulation) Act, 2021

  • Provisions:
    • Under the Surrogacy (Regulation) Act, 2021, a woman who is a widow or a divorcee between the age of 35 to 45 years or a couple,defined as a legally married woman and man, can avail of surrogacy if they have a medical condition necessitating this option.
    • It alsobans commercial surrogacy, which is punishable with a jail term of 10 years and a fine of up to Rs 10 lakhs.
    • The law allows only altruistic surrogacywhere no money exchanges hands and where a surrogate mother is genetically related to those seeking a child.
  • Challenges:
    • Exploitation of the Surrogate and the Child:
      • One could argue that the state must stop the exploitation of poor women under surrogacy and protect the child’s right to be born. However, the current Act fails to balance these two interests.
    • Reinforces Patriarchal Norms:
      • The Act reinforces traditional patriarchal norms of our society that attributes no economic value to women’s workand, directly affecting the fundamental rights of the women to reproduce under Article 21 of the constitution.
    • Denies Legitimate income to Surrogates:
      • Banning commercial surrogacy also denies a legitimate source of income of the surrogates,further limiting the number of women willingly to surrogate.
      • Overall, this step indirectly denies children to the couples choosing to embrace parenthood.
    • Emotional Complications:
      • In altruistic surrogacy, a friend or relative as a surrogate mother may lead to emotional complications not only for the intending parents but also for the surrogate child as there is great deal of risking the relationship in the course of surrogacy periodand post birth.
      • Altruistic surrogacy alsolimits the option of the intending couple in choosing a surrogate mother as very limited relatives will be ready to undergo the process.
    • No Third-Party Involvement:
      • In an altruistic surrogacy, there is no third-party involvement.
      • A third-party involvement ensures that the intended couple will bear and support the medical and other miscellaneous expensesduring the surrogacy process.
      • Overall, a third party helps both the intended couple and the surrogate mother navigate through the complex process, which may not be possible in the case of altruistic surrogacy.

Surrogacy

  • Surrogacy is an arrangement in which a woman (the surrogate) agrees to carry and give birth to a child on behalf of another person or couple (the intended parent/s).
  • A surrogate, sometimes also called a gestational carrier, is a woman who conceives, carries and gives birth to a child for another person or couple (intended parent/s).
  • Altruistic surrogacy:
    • It involves no monetary compensation to the surrogate mother other than the medical expenses and insurance coverage during the pregnancy.
  • Commercial surrogacy:
    • It includes surrogacy or its related procedures undertaken for a monetary benefit or reward (in cash or kind) exceeding the basic medical expenses and insurance coverage.

Assisted Reproductive Technology

  • ART is used to treat infertility. It includes fertility treatments that handle both a woman''s egg and a man''s sperm.It works by removing eggs from a woman''s body and mixing them with sperm to make embryos. The embryos are then put back in the woman''s body.
  • In Vitro fertilization(IVF) is the most common and effective type of ART.
  • ART proceduressometimes use donor eggs, donor sperm, or previously frozen embryos. It may also involve a surrogate carrier.

In-Vitro Fertilisation

In-vitro fertilisation (IVF) is an assisted reproductive technology (ART) where an egg and a sperm are fertilised outside a woman’s body in a laboratory. It is a process that is used to overcome infertility and support surrogacy.

It was first successfully performed in 1978, when IVF gave birth to Louis Brown. Lesley Brown, his mother, had been facing infertility issues since 9 years when she took help from Patrick Steptoe and Robert Edwards at Dr Kershaw’s Cottage Hospital in Royton, Oldham, England.

In-Vitro fertilisation procedure: It involves fertilizing an egg outside the body, in a laboratory dish, and then implanting it in a woman’s uterus. Why is there a need? Infertility is known to affect one in eight couples worldwide. In India alone, infertility affects nearly 10 to 15 per cent of married couples. In the traditional natural way, the egg gets fertilised by sperms deposited in the vagina, with the most able sperm entering the egg after travelling through the woman’s uterus and fallopian tubes. The fertilised egg then divides and forms an embryo in the fallopian tube which then travels back to the uterus to get implanted. However, if natural or unassisted conception is not possible, fertility treatment is an option. In an IVF cycle, the sperms that are obtained either from the ejaculated semen sample or sperms that are directly removed from the testis, are either kept in the close vicinity of the egg in petri dishes or are directly injected inside the egg by the embryologist and grown in the lab for five days under the strict supervision of the embryologist (IVF baby’s “first babysitter”). The best looking embryo is selected and transferred by the IVF specialist doctor into the uterus for implantation. Steps involved for IVF Suppressing the natural menstrual cycle: The woman receives a drug, usually in the form of a daily injection for about 2 weeks, to suppress their natural menstrual cycle. Super ovulation: Fertility drugs containing the fertility hormone follicle stimulating hormone (FSH) are given to the woman. FSH makes the ovaries produce more eggs than usual. Vaginal ultrasound scans can monitor the process in the ovaries. Retrieving the eggs: The eggs are collected through a minor surgical procedure known as “follicular aspiration.” A very thin needle is inserted through the vagina and into an ovary. The needle is which is connected to a suction device. This sucks the eggs out. This process is repeated for each ovary. In 2011, researchers suggested that collecting 15 eggs from the ovaries in one cycle gives the highest chance of a successful pregnancy. Frozen or donated eggs may also be used. Insemination and fertilization: The eggs that have been collected are placed together with male sperm and kept in an environmentally controlled chamber. After a few hours, the sperm should enter the egg. Sometimes the sperm is directly injected into the egg. This is known as an intracytoplasmic sperm injection (ICSI). Frozen sperm, retrieved through testicular biopsy, may be used. This is believed to be as effective as fresh sperm in achieving a successful pregnancy. The fertilized egg divides and becomes an embryo. One or two of the best embryos are selected for transfer. The woman is then given progesterone or human chorionic gonadotrophin (hCG) to help the lining of the womb receive the embryo. Embryo transfer: Sometimes, more than one embryo is placed in the womb, if no ideal embryos are available. The transfer of the embryo is done using a thin tube, or catheter. It enters the womb through the vagina. When the embryo sticks to the lining of the womb, healthy embryo growth can begin. The IVF pregnancy is always confirmed with BHCG levels in the blood. Miscarriages The incidence of miscarriages is slightly higher in women with IVF pregnancies despite being under strict supervision and receiving more medications than those with a natural pregnancy. The reasons for this are most likely attributed to the higher incidence of elderly women with some medical conditions like diabetes or hypertension, presence of fibroids and higher incidence of aneuploid embryos (embryos with abnormal number of chromosomes).

In Human Being, normally in which one of the following parts, does the sperm fertilize the ovum?. (UPSC PRELIMS 2007 Question)

(a) Cervix

(b) Fallopian Tube

(c) Lower Part of uterus

(d) Upper Part of uterus

After the release of sperm into the female reproductive tract, these sperms being motile swim through the vagina to the cervix to the uterus and further up to the fallopian tube.

The fallopian tube is made of three regions:-

  1. Infundibulum: It is the funnel-shaped part of the fallopian tube that possesses finger-like projections called fimbriae at its edges which help in the collection of the ovum after ovulation.
  2. Ampulla: Ampulla is the wider part of the fallopian tube after the infundibulum.
  3. Isthmus: The isthmus is a narrow region of the fallopian tube that joins the uterus. Sperm travels from isthmus to ampulla.

The egg is collected by the fimbriae of the infundibulum and pushed by ciliated columnar epithelial cells to the ampullary region where sperm fertilize the egg.

Procedure

The five steps of in-vitro fertilisation are as follows:

  1. Stimulation / Superovulation

Normally, a woman produces one egg per month. But for IVF procedures, doctors give drugs to women to produce several eggs in a month. These eggs are examined from time to time to pick the healthiest one in the next step.

  1. Retrieval of Egg and Sperm Preparation

The eggs are retrieved from the female by a procedure known as transvaginal oocyte retrieval. An oocyte selection is performed to select the egg that has the highest chance of fertilisation. The sperms are extracted from semen by removing inactive cells and seminal fluid in a process called sperm washing.

  1. Egg Fertilisation

The female egg and male sperm are incubated together for fertilisation. The sperm generally enters the egg and insemination is carried out, but in cases where sperm motility is low, the sperm is directly injected into the egg.

  1. Embryo Development

The fertilised egg divides to form an embryo. The embryo divides by cleavage to form a blastocyst (after 5-6 days of incubation).

  1. Embryo Transfer

The embryo is transferred to the uterus after 5-6 days of active division. The number of embryos that are transferred depends on the age of women and any other health concerns if present. The embryos are transferred through a tube-like apparatus called a catheter which goes up through her cervix and vagina into the womb. The embryo then sticks to the uterine lining and results in pregnancy.

 

  • Legal Provisions:
    • The ART (Assisted Reproductive Technology Act) Regulation 2021 providesa system for the implementation of the law on surrogacy by setting up of the National Assisted Reproductive Technology and Surrogacy Board.
    • The Act aims at the regulation and supervision of ART clinics and assisted reproductive technology banks, prevention of misuse, and safe and ethical practice of ART services.

Offences and Punishment

The following acts are recognized as offences under the law and attract the corresponding punishment:

  • Undertaking or advertising commercial surrogacy Imprisonment extending to ten years and fine extending to Rupees ten lakhs
  • Abandoning, disowning or exploiting the child born out of surrogacy - Imprisonment extending to ten years and fine extending to Rupees ten lakhs
  • Exploiting the surrogate mother - Imprisonment extending to ten years and fine extending to Rupees ten lakhs
  • Selling, importing or trading in human embryos or gametes for the purpose of surrogacy - Imprisonment extending to ten years and fine extending to Rupees ten lakhs
  • Conducting sex selection - Imprisonment extending to ten years and fine extending to Rupees ten lakhs

Any medical practitioner who commits any offence under the Act shall be punished with imprisonment extending upto five years and fine extending upto Rupees ten lakhs. If a subsequent offence is reported by the same person, he shall be reported to the appropriate authority and the State Medical Council for the suspension of his registration for five years.

 

  • Shortcomings:
    • Exclusion of Unmarried and Hetrosexual Couples:
      • The Act excludes unmarried men, divorced men, widowed men, unmarried yet cohabiting heterosexual couples, trans persons and homosexual couples (whether married or cohabiting) from availing ART services.
      • This exclusion is relevant as the Surrogacy Act also excludes above said persons from taking recourse to surrogacy as a method of reproduction.
    • Reduces the Reproductive Choices:
      • The Act is also limited to those commissioning couples who are infertile - those who have been unable to conceive after one year of unprotected coitus. Thus, it is limited in its application and significantly reduces the reproductive choices of those excluded.
    • Unregulated Prices:
      • The prices of the services are not regulated; this can certainly be remedied with simple directives.

Looking Ahead

As India is one of the major hubs of these practices, the Act is certainly a step in the right direction. There, however, needs to be a dynamic oversight to ensure that the law keeps up with rapidly evolving technology, demands of morality and societal changes.



POSTED ON 10-10-2022 BY ADMIN
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