New laws to regulate assisted reproductive technology in India will be introduced to Parliament later this year. The text of the Assisted Reproductive Technology (Regulation) Bill 2008 was published last month by the Indian Council of Medical Research (ICMR) for public comment. The bill aims to regulate surrogacy arrangements in the country where regulation is lacking, in addition to other technologies including pre-implantation genetic diagnosis (PGD) and research on embryos.
The bill will set up a National Advisory Board for Assisted Reproductive Technology to oversee the delivery of the services in the country. A regulatory body, the Registration Authority, will grant licences to fertility clinics to store gametes and offer fertility services. Embryo research must be performed on embryos donated for research and not stored beyond 14 days. Researchers must apply for a licence from the Registration Authority to perform research on embryos. The bill will also make it a criminal offence to perform sex-selection procedures except to prevent or treat a sex-linked disorder or disease.
Media reports last August about a baby girl, Manyi Yamada, showed inadequacies in India's regulation of surrogacy, which was legalised in 2002. Manyi was born to an Indian surrogate mother, but the Japanese couple who arranged the surrogacy split up prior to the birth of the child. The child's biological father sought parental rights over the child but Indian laws were not clear on the status of foreign parents involved in surrogacy arrangements within its borders and the matter had to be decided in the
courts. The new bill will clarify this area by making a surrogate child the legitimate child of a separated or divorced couple. Foreigners seeking surrogacy arrangements in the country will be required to register with their embassy and will have to state with whom the child should be looked after in the event of one of the parent's death. Following surrogacy, the child's birth certificate will show the names of both genetic parents. The bill also forbids women under 21 from entering into surrogacy arrangements and from having more than three live births in their lifetime. Once a surrogate child attains the age of 18, they may apply for information about their surrogate parent.
India's Health Ministry does not keep official statistics on the number of surrogate births in the country but it is believed to be low. Media reports suggest that surrogacy arrangements in India can attract surrogate fees of between $12,000 to $30,000, with the industry being worth around $445m. The bill does not ban offering surrogate mothers compensation for their services. Dr P M Bhargava, a member of the ICMR who helped draft the bill, told the Times of India that, 'considering all the news about surrogacy, including the recent case of the Japanese child, we realised that the new law addresses all the problem areas'.
The bill was timetabled to be debated by the Indian Parliament in the winter session. It met with stiff opposition from the Medical community and will be now reviewed by the Indian Law Ministry.
Monday, October 27, 2008
Sunday, October 26, 2008
P'njaab Airways : In-Flight Announcement
Gud marning, Ladies and Gen'lemen. P'rajee aur Behnjee. Sat Sri Akal.
On behalf of Captaan Balbir Singh 'Bobby', this is your Flight Supervisor Banta Singh "Bunty" welcoming to you on the P'njaab Airways flight no. 9211 (Nau Do Gyaraah) to Ludhiana.
We apalogize for the two-day delay in taking off, b'cause the sun was not shining brightly in the fog. And we are knowing the sun does not shine in the night.
Landing in Ludhiana is not dafinite, but with good luck we can be landing d'rectly in your v'llage.
P'njaab Airways has exc'llant record for safety. In fact our safety standards are so high that even the fully trained tarrists and hijackers are afraid to fly with us.
I am pleased to 'nounce that starting this year over 90% of our p'ssaingers have reached to their dest'nation.
For the rest 10%, the P'njaab Airways staff has lots of experience for consoling the next-of-kin. Our Hostess Bubbly Kaur will be haippy to brief you on our out-of-court settlement policies.
If engines are too noisy, on p'ssainger request, we can turn them off for comfart, but your flight will become late and you may become the late also.
For our religious p'ssaingers, we are the only airline who can help you to contact God at once. In case of sudden loss of cabin pressure, Holy Books will be quickly distributed.
We regret that today's in-flight movie will not be shown as we could not record it from the tallyvision due to power cut.
But we will be flying right naxt to Air India, where their movie can be seen from the right side cabin windows. These windows have been opened
For your viewing convenience. For p'ssaingers on left side, we have put binoculars under the seat.
If AirIndia flight is again cancelled, then for your in-flight ent'tainment. Our hostesses Bubbly Kaur & Cuckoo Kaur will do the Bhangra with flight stewards Pappu and Tappu. Oye, Balle Balle!!
Your in-flight Menu has a choice of Chicken Tikka Masala, Tandoori Fish, Dal makhani, unlimited P'ronthas and Lassi.
There is a half charge for Red Label Whiskey served from Black Label bottles. Patiala pegs will be served only on Patiala flights.
As per safety rules, smoking is not allowed on all P'njaab Airways flights over P'njaab. Any smoke you see in the cabin is only the early warning system on the engines.
Please do read the 'structions on the Safety Card in seat pocket in your front side. It is not a hand fan.
The P'ssainger behind you must read the card in your backside.
Life jackets are placed under your seats for emergency water landings on any of our 5 rivers. Do not use life jackets on the land.
Kindly keep your seat in upright position for take-off & landing. Also do not use force. Broken seats will not be replaced and you will be tied to the floor during take off and landing.
Please be seated first and then fasten your seatbelts. Do not call for steward or airhostess for a glass of water when plane is taking off.
We are about to take-off. We wish you a pleasant flight. For air sikness problems we have echo friendly jute bags in the sit pokets
Thank you once again for flying with P'njaab Airways
On behalf of Captaan Balbir Singh 'Bobby', this is your Flight Supervisor Banta Singh "Bunty" welcoming to you on the P'njaab Airways flight no. 9211 (Nau Do Gyaraah) to Ludhiana.
We apalogize for the two-day delay in taking off, b'cause the sun was not shining brightly in the fog. And we are knowing the sun does not shine in the night.
Landing in Ludhiana is not dafinite, but with good luck we can be landing d'rectly in your v'llage.
P'njaab Airways has exc'llant record for safety. In fact our safety standards are so high that even the fully trained tarrists and hijackers are afraid to fly with us.
I am pleased to 'nounce that starting this year over 90% of our p'ssaingers have reached to their dest'nation.
For the rest 10%, the P'njaab Airways staff has lots of experience for consoling the next-of-kin. Our Hostess Bubbly Kaur will be haippy to brief you on our out-of-court settlement policies.
If engines are too noisy, on p'ssainger request, we can turn them off for comfart, but your flight will become late and you may become the late also.
For our religious p'ssaingers, we are the only airline who can help you to contact God at once. In case of sudden loss of cabin pressure, Holy Books will be quickly distributed.
We regret that today's in-flight movie will not be shown as we could not record it from the tallyvision due to power cut.
But we will be flying right naxt to Air India, where their movie can be seen from the right side cabin windows. These windows have been opened
For your viewing convenience. For p'ssaingers on left side, we have put binoculars under the seat.
If AirIndia flight is again cancelled, then for your in-flight ent'tainment. Our hostesses Bubbly Kaur & Cuckoo Kaur will do the Bhangra with flight stewards Pappu and Tappu. Oye, Balle Balle!!
Your in-flight Menu has a choice of Chicken Tikka Masala, Tandoori Fish, Dal makhani, unlimited P'ronthas and Lassi.
There is a half charge for Red Label Whiskey served from Black Label bottles. Patiala pegs will be served only on Patiala flights.
As per safety rules, smoking is not allowed on all P'njaab Airways flights over P'njaab. Any smoke you see in the cabin is only the early warning system on the engines.
Please do read the 'structions on the Safety Card in seat pocket in your front side. It is not a hand fan.
The P'ssainger behind you must read the card in your backside.
Life jackets are placed under your seats for emergency water landings on any of our 5 rivers. Do not use life jackets on the land.
Kindly keep your seat in upright position for take-off & landing. Also do not use force. Broken seats will not be replaced and you will be tied to the floor during take off and landing.
Please be seated first and then fasten your seatbelts. Do not call for steward or airhostess for a glass of water when plane is taking off.
We are about to take-off. We wish you a pleasant flight. For air sikness problems we have echo friendly jute bags in the sit pokets
Thank you once again for flying with P'njaab Airways
Saturday, October 25, 2008
Friday, October 24, 2008
Catholic Mothers
Even if you didn't grow up Catholic, you'll appreciate this one....
Four Catholic ladies are having coffee together, discussing how important
their children are.
The first one tells her friends, 'My son is a priest. When he walks
into a room, everyone calls him 'Father.'
The second Catholic woman chirps, 'Well, my son is a Bishop.
Whenever he walks into a room, people say, 'Your Grace' The third Catholic woman says smugly, 'Well, not to put you
down, but my son is a Cardinal.
Whenever he walks into a room, people say 'Your Eminence'
The fourth Catholic woman sips her coffee in silence
The first three women give her this subtle 'Well...?
She replies, 'My son is a gorgeous, 6'4', hard bodied, well hung, male stripper.
Whenever he walks into a room, women say, 'Oh! ...'My God'!!!
Four Catholic ladies are having coffee together, discussing how important
their children are.
The first one tells her friends, 'My son is a priest. When he walks
into a room, everyone calls him 'Father.'
The second Catholic woman chirps, 'Well, my son is a Bishop.
Whenever he walks into a room, people say, 'Your Grace' The third Catholic woman says smugly, 'Well, not to put you
down, but my son is a Cardinal.
Whenever he walks into a room, people say 'Your Eminence'
The fourth Catholic woman sips her coffee in silence
The first three women give her this subtle 'Well...?
She replies, 'My son is a gorgeous, 6'4', hard bodied, well hung, male stripper.
Whenever he walks into a room, women say, 'Oh! ...'My God'!!!
Thursday, October 23, 2008
Understanding embryo implantation offers insight
Scientists at the University of Oxford, UK, believe they have identified the way in which embryos implant in the uterus, providing essential information which may be used in the future for infertility treatments and offering hope to thousands of infertile couples. Implantation of an embryo to the lining of the mother's uterus is an essential process that takes place at an early stage of development. The embryo initially attaches and forms a contact with the uterus lining, which triggers a cascade of signals in both the embryo and the uterus. This allows cells from the embryo to start moving across into the uterus, finding blood vessels in the mother and eventually forming the placenta. Problems in the implantation process can lead to loss of potential pregnancies, even in couples trying to conceive without infertility problems. Current estimates suggest that infertility affects one in seven couples in the UK, with around 32,000 couples seeking infertility treatment each year. It is thought that a significant number of these patients could be infertile as a result of implantation problems.
The team of scientists, led by Professor Helen Mardon from the Nuffield Department of Obstetrics and Gynaecology at Oxford, along with Professor Anne J Ridley at King's College, London, added embryos to a layer of cells from uterus lining in a culture dish to mimic events in the womb. They were then able to video embryos implanting themselves in the cell layer, allowing
the scientists to dissect the molecular processes involved. Their findings were published in the journal Proceedings of the National Academy of Sciences.Their investigation led them identify two proteins that are essential players in the implantation process. They are from the Rho GTPase family of proteins, and ensure that cells in a particular part of the uterus lining
move out of the way of the 'invading' embryonic cells. Professor Mardon said: 'We have shown that two proteins, called Rac1 and RhoA, control the invasion. The first stimulates cells in the womb lining to move and allow the embryo to invade and implant properly while the second inhibits this. We believe this controlled balance of the two proteins is critical for successful implantation of the embryo. If the balance of RhoGTPases is altered, the cells of the womb lining don't migrate and the
embryo doesn't implant'.
The findings bring new hope to people with infertility issues. The new information will help the understanding of how this process works, and therefore aid 'the development of drugs to help embryos implant properly',
said Prof Mardon.
The team of scientists, led by Professor Helen Mardon from the Nuffield Department of Obstetrics and Gynaecology at Oxford, along with Professor Anne J Ridley at King's College, London, added embryos to a layer of cells from uterus lining in a culture dish to mimic events in the womb. They were then able to video embryos implanting themselves in the cell layer, allowing
the scientists to dissect the molecular processes involved. Their findings were published in the journal Proceedings of the National Academy of Sciences.Their investigation led them identify two proteins that are essential players in the implantation process. They are from the Rho GTPase family of proteins, and ensure that cells in a particular part of the uterus lining
move out of the way of the 'invading' embryonic cells. Professor Mardon said: 'We have shown that two proteins, called Rac1 and RhoA, control the invasion. The first stimulates cells in the womb lining to move and allow the embryo to invade and implant properly while the second inhibits this. We believe this controlled balance of the two proteins is critical for successful implantation of the embryo. If the balance of RhoGTPases is altered, the cells of the womb lining don't migrate and the
embryo doesn't implant'.
The findings bring new hope to people with infertility issues. The new information will help the understanding of how this process works, and therefore aid 'the development of drugs to help embryos implant properly',
said Prof Mardon.
Wednesday, October 22, 2008
Egg-sharing and Cryopreservation: for who's benefit?
Nataly Atalla's uncritical advertorial 'freeze and share: an evolution of egg sharing' in BioNews 476 (week 15/9/2008 - 21/9/2008) did not address a number of important points.
I would have expected some comment on the success rate of the vitrification technique in their hands. She cites 100,000 procedures in 12 countries and 95 per cent survival and 96 per cent fertilisation rates being reported, but makes no mention of live delivery rates and in particular no reference to the results at her own unit, the London Bridge Fertility Gynaecology and Genetics Centre (the Bridge Centre). Results presented at the recent European Society of Human Reproduction and Embryology (ESHRE) meeting in Barcelona were very encouraging. Chang et al in Atlanta, Georgia, US, vitrified and warmed 155 mature donated oocytes, 135 survived and 117 fertilised with ICSI. They transferred 52 blastocysts into 20 recipients and detected 29 fetal hearts in 17 recipients (1).
However, great care needs to be taken when comparing results elsewhere with those in the UK. In the US, success rates per fresh cycle of egg donation treatment are commonly quoted as being over 60 per cent, whereas the Bridge Centre's most recent published results (HFEA 2007 clinical pregnancy data) was 27 per cent (9/34). This discrepancy is probably due to
the age of the donors - 23 year-old eggs can always be expected to do better than 33 year-old eggs. The vitrification technique may prove to be better than slow freezing but cryopreservation followed by IVF and embryo transfer cannot be expected to give better results than those achieved with fresh embryos. Further, slow freezing results vary from clinic to clinic and the same is likely to be the case with vitrification. Vitrification is more demanding in the laboratory than freezing because precisely controlled exposure to the vitrification solution before cooling and the subsequent rate of warming are critical for survival (2). In the 'freeze and share' scheme, vulnerable women as they approach their mid-30s are being encouraged to put their faith in a storage technique with as yet unproven efficacy in the hands of a clinic offering to exchange storage for eggs to donate to other women. These women may then delay childbearing, become infertile, not conceive with their own stored eggs and know that a woman or women conceived with the fresh eggs they donated some years previously.
How many eggs should the donor store to give herself a 'reasonable' chance of success should she find she needs to use them? Motta et al in Sao Paulo, Brazil and Michigan, US, using excess eggs vitrified and stored and subsequently, if the woman did not conceive following fresh embryo transfer, warmed and ICSI'd, achieved a clinical pregnancy rate of 38 per cent (3).
Although the eggs they used were provided by women with a fertility problem this result is much more like what we could expect in the UK. They estimated that 17 cryopreserved oocytes were required to establish a single clinical pregnancy. At the Bridge Centre suitable donors will undergo three treatment cycles in a year. If they are to store that number of eggs they will need, in order to give half to the recipient, to produce 34 mature eggs, say a total of 40 eggs from about 50 - 60 follicles. It can be seen that this will require a degree of overstimulation with the risks that that would incur.
What proportion of women storing their eggs will need them later? Atalla's commentary makes it clear that only women who are likely to respond to relatively low doses of fertility drugs will qualify to be donors. These women are less likely than those not suitable to donate to have difficulty conceiving in their late thirties and early forties. It appears therefore that the women who are least likely to need the eggs are storing their eggs - perhaps the idea is that they will donate these eggs to the women who were not suitable to donate and store their eggs? A win / win situation for the clinic?
References
(1) C.C. Chang et al, 'Clinical evaluation of blastocyst transfer in oocyte cryopreservation cycles' (P-369 Poster. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
(2) M. Wood, 'Vitrified embryos and oocytes: the way forward' (O-092 Oral. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
(3) E. Motta et al, 'Prospective randomised study of human oocyte cryopreservation by slow-rate freezing or vitrification' (P-374 Poster. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
- John Parsons, Lead Consultant for King's Assisted Conception Unit
I would have expected some comment on the success rate of the vitrification technique in their hands. She cites 100,000 procedures in 12 countries and 95 per cent survival and 96 per cent fertilisation rates being reported, but makes no mention of live delivery rates and in particular no reference to the results at her own unit, the London Bridge Fertility Gynaecology and Genetics Centre (the Bridge Centre). Results presented at the recent European Society of Human Reproduction and Embryology (ESHRE) meeting in Barcelona were very encouraging. Chang et al in Atlanta, Georgia, US, vitrified and warmed 155 mature donated oocytes, 135 survived and 117 fertilised with ICSI. They transferred 52 blastocysts into 20 recipients and detected 29 fetal hearts in 17 recipients (1).
However, great care needs to be taken when comparing results elsewhere with those in the UK. In the US, success rates per fresh cycle of egg donation treatment are commonly quoted as being over 60 per cent, whereas the Bridge Centre's most recent published results (HFEA 2007 clinical pregnancy data) was 27 per cent (9/34). This discrepancy is probably due to
the age of the donors - 23 year-old eggs can always be expected to do better than 33 year-old eggs. The vitrification technique may prove to be better than slow freezing but cryopreservation followed by IVF and embryo transfer cannot be expected to give better results than those achieved with fresh embryos. Further, slow freezing results vary from clinic to clinic and the same is likely to be the case with vitrification. Vitrification is more demanding in the laboratory than freezing because precisely controlled exposure to the vitrification solution before cooling and the subsequent rate of warming are critical for survival (2). In the 'freeze and share' scheme, vulnerable women as they approach their mid-30s are being encouraged to put their faith in a storage technique with as yet unproven efficacy in the hands of a clinic offering to exchange storage for eggs to donate to other women. These women may then delay childbearing, become infertile, not conceive with their own stored eggs and know that a woman or women conceived with the fresh eggs they donated some years previously.
How many eggs should the donor store to give herself a 'reasonable' chance of success should she find she needs to use them? Motta et al in Sao Paulo, Brazil and Michigan, US, using excess eggs vitrified and stored and subsequently, if the woman did not conceive following fresh embryo transfer, warmed and ICSI'd, achieved a clinical pregnancy rate of 38 per cent (3).
Although the eggs they used were provided by women with a fertility problem this result is much more like what we could expect in the UK. They estimated that 17 cryopreserved oocytes were required to establish a single clinical pregnancy. At the Bridge Centre suitable donors will undergo three treatment cycles in a year. If they are to store that number of eggs they will need, in order to give half to the recipient, to produce 34 mature eggs, say a total of 40 eggs from about 50 - 60 follicles. It can be seen that this will require a degree of overstimulation with the risks that that would incur.
What proportion of women storing their eggs will need them later? Atalla's commentary makes it clear that only women who are likely to respond to relatively low doses of fertility drugs will qualify to be donors. These women are less likely than those not suitable to donate to have difficulty conceiving in their late thirties and early forties. It appears therefore that the women who are least likely to need the eggs are storing their eggs - perhaps the idea is that they will donate these eggs to the women who were not suitable to donate and store their eggs? A win / win situation for the clinic?
References
(1) C.C. Chang et al, 'Clinical evaluation of blastocyst transfer in oocyte cryopreservation cycles' (P-369 Poster. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
(2) M. Wood, 'Vitrified embryos and oocytes: the way forward' (O-092 Oral. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
(3) E. Motta et al, 'Prospective randomised study of human oocyte cryopreservation by slow-rate freezing or vitrification' (P-374 Poster. Abstracts of the 24th Annual Meeting of the ESHRE. Barcelona, Spain, 7-9 July, 2008).
- John Parsons, Lead Consultant for King's Assisted Conception Unit
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