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The phrase “third-party reproduction” refers to the use of eggs, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents. It also includes traditional surrogacy and gestational carrier arrangements.

• Goes beyond the traditional father-mother model
• Limited to the reproductive process; does not extend into the raising of the child
• Ethical, moral, religious and legal concerns play a significant role
• It allows the miracle of childbirth to those who might otherwise be unable to.

Multiple types of 3^rd party reproduction:

Oocyte donation

Sperm Donation

 Embryo Donation

Surrogacy

Oocyte donation:

• Oocyte or Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction.

• Egg donation typically involves the eggs being fertilized in the laboratory.

• Recent developments in freezing techniques allow unfertilized eggs to be frozen and stored for later use.

Who needs Donor Eggs?

• Premature ovarian failure-genetic/medical/surgical/CT/RT
• Postmenopausal women (menopause < 5 y)
• Women above 43y
• Poor quality eggs/poor responders/ repeated IVF failures
• Women with genetic disorders

Sperm Donation in India

• Sperm donation is a procedure in which a man donates semen to help an individual or a couple conceive a baby.

• Donated sperm can be injected into a woman's reproductive organs (intrauterine insemination) or used to fertilize mature eggs in a lab (in vitro fertilization).

Who needs a Sperm Donor?

• Azoospermia with testicular failure
• Severe oligospermia/ Severely abnormal sperm
• Repeated IVF failures due to poor sperm morphology
• Genetic disorders
• Ejaculatory dysfunction
• STD’s that cannot be eradicated
• Severely isoimmunized partner
•  Single women desiring pregnancy

Embryo Donation

• Embryo donation is a procedure by which surplus embryos remaining after one couple's in vitro fertilization are given to either another person or couple for implantation provided the couple has given formal consent to this effect.

• At SOUTHEND FERTILITY & IVF, embryos are specially created for the recipient couple by taking a donor oocyte and a donor sperm. Such an embryo does not belong to anybody and is totally anonymous.
• The donation is followed by the placement of those embryos into the recipient woman's uterus to facilitate pregnancy and childbirth in the recipient.
• The resulting child is considered the child of the woman who carries it and gives birth, and not the child of the donor.

Who needs an Embryo Donor?

• Untreatable infertility involving both partners
• Recurrent pregnancy loss with embryonic cause
• Genetic disorders affecting both partners

Surrogacy

• Arrangement in which a woman agrees to a pregnancy achieved through ART, in which neither of the gametes belongs to her or her husband, with the intention to carry it to term and hand over the child to the person or persons for whom she is acting as a surrogate.
•  Two Types of Surrogacy

Commercial

• Surrogates are paid for carrying a child to maturity in her womb
• This is legal in several countries including in India

Altruistic

• Surrogate receives no financial reward for her pregnancy
• All expenses such as medical expenses, maternity clothing, and other related expenses related to the pregnancy and birth are paid by the intended parents

Surrogacy in India

Nowadays surrogacy solutions have gained popularity in India. Previously, Surrogacy in India was a bit different as well as complex from abroad, but now it has become simpler for childless parents to bring back happiness in their lives. A surrogate mother in India is now given more importance and privacy as compared to their condition in the past. With the development of infertility treatment in India, even surrogacy India has gained popularity.

The Indian government’s Proposed Surrogacy Bill has made some changes such as banning commercial surrogacy, foreigners can't get Indian surrogate mothers, legalizing surrogacy only for infertile heterosexual married Indian couples who are married for more than 5 years, a surrogate mother is India should not be paid, only a close relative can approached for surrogacy, you can’t try surrogacy if you already have a child and the last surrogacy is only allowed once in your lifetime.

The Indian government has also proposed to establish a National Surrogacy Board at the central level that can be led by the health minister, and State Surrogacy Boards and the appropriate authorities in the states as well as union territories. All these officials will take care of all cases of surrogacy and regulate hospitals and clinics that offer surrogacy solutions in India.

Who needs Surrogacy?

• Absence of uterus (MRKHS)
• Post hysterectomy(benign/malignant condition)
• T shaped/hypoplastic uterus
• Repeated implantation failure
• Untreatable intrauterine scar
• Medical disorders- uncontrolled & severe diabetes/HTN, Severe heart disease, renal disorders, SLE, ankylosing spondylitis,
• Obstetric factors- h/o placenta increta in prev. pregnancy/severe HELLP

Our Strengths:

• Very high success rates 70 – 80%
• Personally selected appropriate donors.
• Stringent criteria for donor screening.

Selection of Donors:

Our donors are of two kinds:

1. Donors from within the patient pool.

Some women are with us because their husbands have a severe male problem. Such women are potentially fertile since they do not have any problem themselves. These women are then counseled to become donors and are informed that they would be compensated for their eggs. In our center, the recipient pays for the donor's medication in lieu of her oocytes. The only disadvantage of such patients is that they are not of proven fertility.

2. Professional Donors:

Such donors are selected through ART banks or advertisements. If they are found suitable after screening, they enter our program. The bank takes a charge for their services and also have to be paid for the medication.

Preparation of the intended parent/recipient:

There are two types of recipients and the protocol varies accordingly.

• Women without ovarian function(if you do not get periods naturally or get them only when you take pills):
• Women with ovarian function (if you get periods naturally without pills)

Different protocols are given to them so that they match the donor.

In both regimens, progesterone is started one day prior to the day the donor receives the HCG trigger. Inj.A gemstone is started in a dose of 50 mg. I/M daily. The monitoring of the cycle may be done with U/S scan. We like to do blood flow studies of the endometrium and consider it to be receptive if the thickness is above 8mm. and texture is normal. Blood flow should be evident until the inner layer of the endometrium.