ART is a group of techniques where conception happens outside a woman's body in the laboratory under carefully controlled conditions. Here no attempt is made to cure the patient , the target is simply to achieve pregnancy. The possibility of a continuing pregnancy being achieved by ART has improved from practically nil to one chance in 3 to 5 at IVF centers worldwide. In Vitro Fertilization-Embryo Transfer (IVF-ET) popularly called Test Tube Baby is a fertility procedure which first succeeded as recently as 1978 by Dr. Edwards (an embryologist) and Dr. Steptoe (a gynaecologist) in England. The world's second and India's first IVF baby, Kanupriya, alias Durga, was born merely 67 days later through the efforts of Dr Subhas Mukherjee and his two colleagues in Kolkata. Since then the technology has been further refined and developed by physicians and embryologists and several other ART procedures are developed.
Generally ART is viewed as a treatment of the last resort. Because of media participation and globalization of market economy, the technology has travelled to all corners of the world. Now the instruments, the drugs and the skilled workers in the field are easily available anywhere in the world. All this has made ART popular, acceptable, accessible and cost effective.
Various ART Procedures are:
IVF-ET: - In Vitro Fertilization and Embryo Transfer (extraction of oocyte, fertilization in lab and transfer of the embryos into the uterus).
GIFT: - Gamete Intra Fallopian Transfer (placement of the oocyte and the sperm into fallopian tube).
ZIFT: - Zygote Intra Fallopian Transfer (placement the fertilized oocytes into the fallopian tube).
TET:- Tubal Embryo Transfer (placement of embryos into the fallopian tubes)
POST :- Peritoneal Oocytes and Sperm Transfer( placement of the oocytes and sperm into the pelvic cavity)
ICSI: - Intra Cytoplasmic Sperm Injection.
TESA: - Testicular Sperm Extraction.
MESA: - Microsurgical Epididymal Sperm Aspiration.
MIST: - Micro Insemination Spermatozoa Transfer.
IVF-ET and ICSI are the most widely accepted technologies.
At our centre we impart the following information to the couple seeking ART treatment before the start of procedure.
- Elaborate how ART can be helpful to resolve their infertility problem. He, however, should not affect the decision of the couple.
- The limitations and possible outcome of the ART procedure proposed and variations in its effectiveness over time is discussed in the start. The documented data of the results of centre and other authentic centres around the world should be presented before the couple.
- Information regarding the efficacy, risks (to the women and the resulting child) and possible discomfort of the proposed therapy are discussed in the beginning.
- We at our centre discuss the risks associated with multiple pregnancies in ART and the need to reduce the number of viable fetuses, in order to ensure the survival of at the most two fetuses
- The couple is also informed about the possible disruption of the their domestic life during the period of treatment.
- The advantages of storage of gametes or embryos and their possible deterioration associated with storage.
- The cost (with suitable break-up) of the treatment proposed and of an alternative treatment, if any is discussed before the start of procedure.
- The couple is told regarding the importance of informing the clinic of the result of the pregnancy.
- We also clarify the Legal, religious and cultural issues linked to ART.
- The couple counceled regarding the advantages and disadvantage of continuing treatment after a certain number of attempts. They also counseled to consider adoption/child free living as an appropriate measure.
- We take the informed written consent from the couple before the start of the treatment process.
- The consent form briefing the limitation and possible out come of procedure and success rate is signed by both partners and endorsed by service provider in the presence of witness preferably.
The patient is advised to read detail from The Assisted Reproduction Technologies (Regulations) Rules 2010, Ministry of Health and Family Welfare, Government of India. However, the high light are given below.
- The child will be legitimate child of the couple.
- He/she will have identical legal rights.
- The birth certificate shall bear the names of the parents.