THE

ASSISTED REPRODUCTIVE TECHNOLOGY

(REGULATION) BILL, 2008

AN ACT

to provide for a national framework for the regulation and supervision of assisted
reproductive technology and matters connected therewith or incidental thereto.

BE IT ENACTED by the Parliament in the 58th year of the Republic of India as

follows:

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 CHAPTER - I

PRELIMINARY

1. Short title, extent and commencement

(1) This Act may be called the Assisted Reproductive Technology

(Regulation) Act, 2008.

(2) It applies, in the first instance, to the whole States of .. and

.. and the Union Territories; and it shall
apply to such other States which adopt this Act by resolution passed in
that behalf under Clause (1) of Article 252 of the Constitution.

(3) It shall come into force at once in the States of . and

.. and the Union Territories, on such dates as the
Central Government may, by notification appoint, and in any other
States which adopt this Act under Clause (1) of Article 252 of the
Constitution, on the date of such adoption; and any reference in this
Act to the commencement of this Act shall, in relation to any State or
Union Territory, mean the date on which this Act comes into force in
such a State or Union Territory.

2. Definitions In this Act, and in any rules and regulations framed hereunder,
unless the context otherwise requires

a artificial insemination, means the procedure of artificially transferring

semen into the reproductive system of a woman and includes
insemination with the husbands semen or with donor semen;

b assisted reproductive technology, with its grammatical variations and

cognate expressions, means all techniques that attempt to obtain a
pregnancy by handling or manipulating the sperm or the oocyte outside
the human body, and transferring the gamete or the embryo into the
uterus;

c assisted reproductive technology clinic, means any premises used for

procedures related to assisted reproductive technology;

d child, means any individual, of whatever age, born through the use of
assisted reproductive technology;

e. couple, means the persons living together and having a sexual

relationship that is legal in the country / countries of which they are
citizens or they are living in;

f cryo-preservation, means the freezing and storing of gametes,

zygotes and embryos;

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g donor, means the donor of a gamete or gametes but does not include
the husband who provides the sperm or the wife who provides the
oocyte to be used in the process of assisted reproduction for their own
use;

h embryo, means the fertilized ovum that has begun cellular division
and continued development up to the blastocyst stage till the end of
five days;

i fertilization, means the penetration of the ovum by the spermatozoon

and fusion of genetic materials resulting in the development of a
zygote;

j foetus, means the product of conception, starting from completion of

embryonic development until birth or abortion;

k gamete", means sperm and oocyte;

l gamete donor, means a person who provides sperm or oocyte with

the objective of enabling an infertile couple to have a child;

m Indian Council of Medical Research, means the Indian Council of

Medical Research as registered under the Societies Registration Act,
1860;

n implantation, means the attachment and subsequent penetration by

the zona-free blastocyst, which starts five to seven days following
fertilization;

o infertility, means the inability to conceive after at least one year of

unprotected coitus;

p oocyte and ovum, mean, respectively, the female gamete present in

the ovary, and an ovulated oocyte in which the first polar body has
been released;

q Pre-implantation Genetic Diagnosis, includes the technique in which

an embryo formed through in-vitro fertilisation is tested for specific
disorders prior to the transfer;

r semen bank, shall be deemed to include both sperm and oocytes;

s sperm, means the male gametes produced in the testicles and

contained in semen ejaculated by a male;

t surrogacy, means an arrangement in which a woman agrees to a

pregnancy, achieved through assisted reproductive technology, in
which neither of the gametes belong to her or her husband, with the

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 intention to carry it to term and hand over the child to the person or
persons for whom she is acting as a surrogate;

u surrogate mother, means a woman who agrees to have an embryo

generated from the sperm of a man who is not her husband and the
oocyte of another woman, implanted in her to carry the pregnancy to
full term and deliver the child to its biological parent(s);

v surrogacy agreement, means a contract between the person(s)

availing of assisted reproductive technology and the surrogate mother;

w unmarried couple, means a man and a woman, both of marriageable

age, living together with mutual consent but without getting married;

x zygote, means the fertilized oocyte prior to the first cell division.

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 CHAPTER - II

CONSTITUTION OF AUTHORITIES TO REGULATE

ASSISTED REPRODUCTIVE TECHNOLOGY

3. Establishment of National Advisory Board

(1) With effect from such date as the Central Government may, by
notification, appoint, there shall be established a Board to be known as
the National Advisory Board for Assisted Reproductive Technology,
hereafter referred to as the National Board, to exercise the jurisdiction
and powers and discharge the functions and duties conferred or
imposed on the Board by or under this Act.

(2) The National Board shall consist of such number of members, not
exceeding twenty one, as may be prescribed by the Central
Government and, unless the rules otherwise provide, the National
Board shall consist of the following

(a) A Chairman to be appointed by the Ministry of Health and

Family Welfare;

(b) An officer, not below the rank of Joint Secretary from the Indian
Council of Medical Research, who shall be the Member-
Secretary of this Board;

(c) A representative, not below the rank of Joint Secretary, from the
Ministry of Health and Family Welfare;

(d) The nominee of an Indian professional society concerned

primarily with assisted reproduction;

(e) Up to sixteen other experts of whom one each shall be a

nominee of the Ministry of Health and Family Welfare and Indian
Council of Medical Research, and at least six of whom shall be
women in the fields of assisted reproduction, gynaecology,
embryology, andrology, bioethics, mammalian reproduction,
medical genetics, social science, law, or human rights, to be
nominated by the Central Government.

(3) The Chairman of National Board shall nominate a Vice Chairman from
among its members.

4. Meetings of National Advisory Board

(1) The National Board shall meet as and when necessary, not less than
two times a year, and at such time and place in the country as the
Chairperson of the National Board may think fit.

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 (2) The Chairperson of the National Board shall preside over the meetings
of the National Board.

(3) If, for any reason, the Chairperson of the National Board is unable to
attend any meeting of the National Board, the Vice-Chairperson of the
National Board shall preside over the meeting.

5. Functions of National Advisory Board

(1) The National Board may recommend modification from time to time in
the attached rules and schedules where relevant in regard to the
following, and perform any other functions and tasks assigned to it by
the Central Government:

(a) minimum requirements related to staff and physical

infrastructure for the various categories of assisted reproductive
technology clinics;

(b) regulations in respect of permissible assisted reproductive

technology procedures;

(c) regulations in respect of selection of patients for assisted

reproductive technology procedures;

(d) encouragement and promotion of training and research in the

field of assisted reproduction;

(e) encouragement of the establishment and maintenance of a

national database in respect of infertility;

(f) guidelines for counselling and providing patients with all

necessary information and advice on various aspects of assisted
reproductive technology procedures;

(g) ways and means of disseminating information related to

infertility and assisted reproductive technologies to various
sections of the society;

(h) regulations in respect of research on human embryos;

(i) proformae for obtaining information from donors of gametes and

surrogate mothers, consent forms for various procedures, and
contracts and / or agreements between the various parties
involved, in all of the languages listed in the Eighth Schedule of
the Constitution;

(j) policies from time to time on assisted reproduction;

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6. Establishment of State Boards

(1) Every State Government shall, within 180 days of the issue of the
notification under sub-section (1) of section 3, by notification in the
Official Gazette, establish a State Board for Assisted Reproductive
Technology to exercise the jurisdiction and powers and discharge the
functions and duties conferred or imposed on the State Boards by or
under this Act.

(2) The State Boards shall consist of such number of members, not
exceeding twelve, as may be prescribed by the State Government and,
unless the rules otherwise provide, the State Boards shall consist of
the following members, namely

(a) The Secretary of the Department of Health and Family Welfare,

who shall be Chairperson, ex officio;

(b) The nominee of an Indian professional society concerned

primarily with assisted reproduction who shall be the Vice
Chairperson, ex officio;

(c) An officer not below the rank of a Joint Secretary, who shall be
the Member-Secretary of the Board;

(d) Up to nine other members of whom at least four shall be

women who shall be experts in the fields of assisted
reproduction, gynaecology, embryology, andrology, bioethics,
mammalian reproduction, medical genetics, social science, law,
or human rights, to be nominated by the State Government.

(3) The Chairman of the State Board shall nominate a Vice Chairman from
among its members.

7. Meetings of State Boards

(1) The State Board shall meet as and when necessary, but not less than
three times a year and at such time and place as the Chairperson of
the State Board may think fit.

(2) The Chairperson of the State Board shall preside over the meetings of
the State Board.

(3) If for any reason the Chairperson of the State Board is unable to attend
any meeting of the State Board, the Vice Chairperson of the State
Board shall preside over the meeting.

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8. Powers and functions of State Boards

(1) Subject to the provisions of this Act and the rules and regulations
adopted thereunder, the State Board shall have the responsibility for
laying down the policies and plans for assisted reproduction in the
State.

(2) Without prejudice to the generality of the provisions contained in sub-

section (1) of this section, the State Board, taking into account the
recommendations, policies and regulations of the National Board, may

(a) advise the State Government to constitute a Registration

Authority or Authorities as required, at least of six experts in
assisted reproduction technology or a related field, for the use of
assisted reproductive technology in the State;

(b) monitor the functioning of the Registration Authority subject, in

particular, to the guidelines laid down by the National Advisory
Board;

(c) coordinate the enforcement and implementation of the policies

and guidelines for assisted reproduction;

(d) constitute advisory committees consisting of experts in the field

of assisted reproduction and related fields at the State or district
level, to make recommendations on different aspects of assisted
reproduction;

(e) perform such other functions prescribed under this Act;

(3) Notwithstanding anything contained in section 12 of this Act, the State

Board may, suo moto, whether on the basis of a complaint or
otherwise, examine and review any decision of the Registration
Authority.

(4) In the exercise of its functions under this Act, the State Board shall give
such directions or pass such orders as are necessary, with reasons to
be recorded in writing.

9. Term of office, conditions of service, etc., of Chairperson and other

members of State Boards

(1) Before appointing any person as the Chairperson or other member, the
appropriate Government shall satisfy itself that the persons integrity is
such that his / her professional interest shall not affect prejudicially his
functions as such member.

(2) The Chairperson and every other Member shall hold office for such
period, not exceeding five years, as may be specified by the

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 appropriate government in the order of his appointment, but shall be
eligible for re-appointment.

(3) Notwithstanding anything contained in sub-section (1) of this section, a

member may by writing under his / her hand and addressed to the
appropriate Government resign his / her office at any time;

(4) A vacancy caused by the resignation or removal of the Chairperson or

any other member shall be filled by fresh appointment.

(5) In the event of the occurrence of a vacancy in the office of the

Chairperson by reason of his / her death, resignation or otherwise,
such one of the members as the appropriate Government may, by
notification, authorise in this behalf, shall act as the Chairperson till the
date on which a new Chairperson, appointed in accordance with the
provisions of this Act to fill such vacancy, takes charge of the office.

(6) When the Chairperson is unable to discharge his / her functions owing
to absence, illness or any other cause, the Vice Chairperson shall
discharge the function of the Chairpersons, till the date on which the
Chairperson resumes his duties.

(7) The salaries and allowances payable to and the other terms and
conditions of service of the Chairperson and other members shall be
such as may be prescribed: provided that neither the salary and
allowances nor the other terms and conditions of service of the
Chairperson or any other member shall be varied to his disadvantage
after his appointment.

(8) The Chairperson and every other member shall, before entering upon
his / her office make a declaration of fidelity and secrecy in the form set
out in the Schedule.

(9) The Chairperson ceasing to hold office as such shall not hold any
appointment or be connected with the management or administration in
any company, hospital, clinic, society, trust or other undertaking in
relation to which any matter has been the subject matter of
consideration before the State Board, for a period of three years from
the date on which he ceases to hold such office.

10. Procedure of State Boards

(1) Subject to the provisions of this Act, the State Board shall have powers to

(a) regulate the procedure and conduct of the business;

(b) delegate its powers or functions to such persons or authorities

as prescribed in the rules or regulations made under this Act.

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 (2) The State Boards shall, for the purposes of any inquiry or for any other
purpose under this Act, have the powers to

(a) summon and enforce the attendance of any witness and

examine him / her on oath;

(b) order the discovery and production of document or other

material objects producible as evidence;

(c) receive evidence on affidavit;

(d) requisition any public record from any court or office;

(e) issue any order for the examination of witnesses;

(f) any other matter which may be prescribed.

11. Constitution and functions of the Registration Authority

(1) The State Government shall constitute the Registration Authority as per
the advise of the State Board, within a period of three months of the
advise.

(2) The Registration Authority shall have a full-time Chairman of the level
of a Secretary to the State Government, who shall be a recognised
expert in assisted reproductive technology or a related field.

(3) The other members of the Registration Authority shall be part-time

members, and shall be adequately compensated for their services.

(4) Before appointing any member of the Registration Authority, the

Government shall satisfy itself that his / her integrity is such that his /
her professional interest shall not affect prejudicially his / her functions
as a member.

(5) The Registration Authority shall be provided by the State Government

with adequate supporting staff and secretarial assistance, and suitable
accommodation.

(6) The Registration Authority shall issue an appropriate letter granting or

rejecting registration to an assisted reproductive technology clinic.

12. Proceedings before State Boards to be judicial proceedings The

National Board and every State Board shall be deemed to be a civil court for
the purposes of section 195 and Chapter XXVI of the Code of Criminal
Procedure, 1973, and every proceeding before the National Board or every
State Board shall be deemed to be a judicial proceeding within the meaning of
sections 193 and 228 and for the purposes of section 196 of the Indian Penal
Code, 1860.

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 CHAPTER - III

PROCEDURES FOR REGISTRATIONS AND COMPLAINTS

13. Registration and accreditation of clinics

(1) All assisted reproductive technology clinics shall, within such period
and in such form and manner as may be prescribed, register
themselves with the Registration Authority.

(2) An application for registration by an assisted reproductive technology

clinic under sub-section (1) of this section shall contain the particulars
of the applicant including all details of techniques and procedures of
assisted reproductive technology practiced at such clinic.

(3) The State Board may, subject to such terms and conditions as may be
prescribed, register any assisted reproductive technology clinic on the
basis of the techniques and procedures of assisted reproductive
technology practiced at such clinic, namely

(a) infertility treatment, including Intra-Uterine Insemination (IUI),

Artificial Insemination with Husbands semen (AIH), and
Artificial Insemination using Donor Semen (AID), involving the
use of donated or collected gametes;

(b) infertility treatment involving the use and creation of embryos

outside the human body;

(c) processing or storage of gametes and embryos;

(d) research on embryos.

(4) Notwithstanding anything contained in this Act or any of the Rules

made thereunder, no assisted reproductive technology clinic
performing any of the functions under sub-section (3) of this section, or
any other advanced diagnostic, therapeutic or research functions, shall
practice any aspect of such diagnosis, therapy or research without a
certificate of accreditation issued by the State Board.

(5) The practice of any aspect of assisted reproductive technology in

contravention of the provisions of this section shall constitute an
offence under this Act.

(6) Assisted reproductive technology clinics registered under this Act shall
be deemed to have satisfied the provisions of the PC & PNDT Act,
1994 [amended in 2002], and shall not be required to seek a separate
registration under the said Act.

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14. Who may apply for registration

(1) Assisted reproductive technology clinics, semen banks and research

organizations using human embryos, operative on the date of
notification of this Act, shall obtain a temporary registration within six
months of the notification of the State Registration Authority by the
State Board, and regular registration within 18 months of the above
notification. If an assisted reproductive technology clinic that has
applied for temporary registration under this clause to the State
Registration Authority does not receive the registration or hear from the
above Authority within 60 days of the receipt of the application by the
Authority, the clinic would be deemed to have received the temporary
registration.

(2) No assisted reproductive technology clinic, semen bank or research

organisation using human embryos, other than the ones specified
above, shall practice any aspect of assisted reproductive technology,
or carry out any research on or using human embryos, or use any
premises for such purposes, without a registration under this Act.

(3) Any assisted reproductive technology clinic or semen bank or research

organisation using human embryos, by whatsoever name called, may
apply to the Registration Authority for registration to operate the clinic,
semen bank or research organisation in accordance with the procedure
and criteria laid down in this Act.

(4) Every application under sub-section (2) of this section shall be in such
form and shall be accompanied by such fee and such documents as
may be prescribed by the State Government.

15. Grant of registration

(1) The Registration Authority may, if it is satisfied that the criteria

specified in the Rules have been met, grant registration to the applicant
for a term of three years under such terms and conditions as it thinks
fit.

(2) The Registration Authority shall, within one month of a registration

being granted under this section, report such registration to the State
Board.

(3) The State Board shall maintain a record of all registrations applied for
and granted under this section.

(4) No registration shall be granted unless the Registration Authority, or

such authorised person or persons acting on its behalf, have inspected
the premises of the applicant.

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16. Renewal, suspension or revocation of registration

(1) The Registration Authority may, on an application made to it in such

form and manner as may be prescribed, renew a registration granted
under the provisions of this Act with effect from the date of its expiry if it
is satisfied that the criteria prescribed in the Schedule continue to be met.

(2) The Registration Authority may at any time suspend the operation of a
registration and call upon the holder of the registration to produce such
documents or furnish such evidence as may be required if it has
reasonable grounds to believe that the terms and conditions of the
registration have not been met.

(3) When acting under sub-section (2) of this section, the Registration
Authority shall either revoke the registration or continue the
registration, as the case may be, after giving the holder of the
registration adequate opportunity to be heard.

(4) The Registration Authority shall inform the concerned State Board of
every assisted reproductive technology clinic in respect of which it has
granted, renewed, revoked or denied a registration under this Act
within one month of such an action being taken.

(5) The Registration Authority shall be deemed to have granted renewal

for three years to the applicant if the applicant does not receive a
definitive communication from the Registration Authority regarding the
renewal application within sixty days of the receipt of the application in
the office of the Registration Authority.

17. Registration Authority to inspect premises In the exercise of its powers

under this Act, the Registration Authority shall have the power to inspect, with
or without prior notice, any premises or call for any document or material in
the discharge of its powers and functions.

18. Applicability to semen banks and research organisations The

provisions of sections 12 to 16 shall apply also to semen banks and research
organisations using human embryos.

19. Appeal to the State Board

(1) Any person aggrieved by the decision of the Registration Authority

made under this Act may, within such period and in such manner and
form as may be prescribed, prefer an appeal to the State Board.

(2) On receipt of an appeal under sub-section (1) of this section, the State
Board may, after giving an opportunity to the appellant to be heard, and
after making such further inquiry as it thinks fit, confirm, modify or set
aside the decision of the Registration Authority, within three months of
the receipt of the appeal.

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 CHAPTER - IV

DUTIES OF AN ASSISTED REPRODUCTIVE TECHNOLOGY CLINIC

20. General duties of assisted reproductive technology clinics

(1) Assisted reproductive technology clinics shall ensure that patients,

donors of gametes and surrogate mothers are eligible to avail of
assisted reproductive technology procedures under the criteria
prescribed by the rules under this Act and that they have been
medically tested for such diseases, sexually transmitted or otherwise,
as may be prescribed and all other communicable diseases which may
endanger the health of the parents, or any one of them, surrogate or
child.

(2) It shall be the responsibility of an assisted reproductive technology

clinic to obtain, from semen bank(s), all relevant information, other than
the name, personal identity and address, of possible gamete donors,
and assist the couple or individual desirous of the donation, to choose
the donor.

(3) When a semen bank receives a request from an assisted reproductive

technology clinic for a donor oocyte, a responsible member of the staff
of the semen bank will accompany the particular donor to the Assisted
Reproductive Technology clinic, and obtain a written agreement from
the authority designated for this purpose by the clinic, that the clinic
shall, under no circumstances (except when asked by a court of law),
reveal the identity of the donor to the recipient couple or individual or to
anyone else; the clinic shall also ensure that all its staff is made aware
of the fact that any step leading to disclosure of the identify (i.e., name
and address) to the recipient couple or individual or to anyone else,
shall amount to an offence punishable under this Act.

(4) Either of the parties seeking assisted reproductive technology

treatment or procedures shall be entitled to specific information in
respect of donor of gametes including, but not restricted to, height,
weight, ethnicity, skin colour, educational qualifications, medical history
of the donor, provided that the identity, name and address of the donor
is not made known.

(5) Assisted reproductive technology clinics shall obtain donor gametes

from semen banks that have ensured that the donor has been
medically tested for such diseases, sexually transmitted or otherwise,
as may be prescribed and all other communicable diseases which may
endanger the health of the parents, or any one of them, surrogate or
child.

(6) Assisted reproductive technology clinics shall provide professional

counselling to patients or individuals about all the implications and
chances of success of assisted reproductive technology procedures in

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 the clinic and in India and internationally, and shall also inform patients
and individuals of the advantages, disadvantages and cost of the
procedures, their medical side effects, risks including the risk of
multiple pregnancy, the possibility of adoption, and any such other
matter as may help the couple or individual arrive at a decision that
would be most likely to be the best for the couple or individual.

(7) Assisted reproductive technology clinics shall make couples or

individuals, as the case may be, aware of the rights of a child born
through the use of assisted reproductive technology.

(8) Assisted reproductive technology clinics shall explain to couples or

individuals, as the case may be, the choice or choices of treatment
available to them and the reason or reasons of the clinic for
recommending a particular treatment, and shall clearly explain the
advantages, disadvantages, limitations and cost of any recommended
or explained treatment or procedure.

(9) Assisted reproductive technology clinics shall ensure that information

about clients, donors and surrogate mothers is kept confidential and
that information about assisted reproductive technology treatment shall
not be disclosed to anyone other than a central database to be
maintained by the Indian Council of Medical Research, except with the
consent of the person or persons to whom the information relates, or in
a medical emergency at the request of the person or persons or the
closest available relative of such person or persons to whom the
information relates, or by an order of a court of competent jurisdiction.

(10) No assisted reproductive technology clinic shall consider conception by

surrogacy for patients for whom it would normally be possible to carry a
baby to term. Provided that where it is determined that unsafe or
undesirable medical implications of such conception may arise, the use
of surrogacy may be permitted.

(11) Assisted reproductive technology clinics shall provide to couples or

individuals, as the case may be, a pre-stamped self-addressed envelop
to inform the clinic of the results of the assisted reproductive
technology procedure performed for the couple or the individual.

(12) No assisted reproductive technology clinic shall obtain or use sperm or

oocyte donated by a relative or known friend of either of the parties
seeking assisted reproductive technology treatment or procedures.

(13) Every assisted reproductive technology clinic shall establish a

mechanism to look into complaints in such manner as may be
prescribed.

(14) No assisted reproductive technology procedure shall be performed on

a woman below 21 years of age, and any contravention of this
stipulation shall amount to an offence punishable under this Act.

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 (15) All assisted reproductive technology clinics shall issue to the infertile
couple / individual a discharge certificate stating details of the assisted
reproductive technology procedure(s) performed on the couple /
individual.

21. Duty of the assisted reproductive technology clinic to obtain written

consent

(1) No assisted reproductive technology clinic shall perform any treatment

or procedure of assisted reproductive technology without the consent in
writing of all the parties seeking assisted reproductive technology to all
possible stages of such treatment or procedures including the freezing
of embryos.

(2) No assisted reproductive technology clinic shall freeze any human

embryos without specific instructions and consent in writing from all the
parties seeking assisted reproductive technology in respect of what
should be done with the gametes or embryos in case of death or
incapacity of any of the parties.

(3) No assisted reproductive technology clinic shall use any human

reproductive material to create an embryo or use an in vitro embryo for
any purpose without the specific consent in writing of all the parties to
whom the assisted reproductive technology relates.

(4) The consent of any of the parties obtained under this section may be
withdrawn at any time before the embryos or the gametes are
transferred to the concerned womans uterus.

22. Duty of assisted reproductive technology clinic to keep accurate

records

(1) All assisted reproductive technology clinics shall maintain detailed

records, in such manner as may be prescribed, of all donor oocytes,
sperm or embryos used, the manner and technique of their use, the
individual or couple or surrogate mother, in respect of whom it was
used, and the deoxyribonucleic acid (DNA) fingerprint of the individual
or couple and the child born as a result of assisted reproductive
technology treatment or procedures.

(2) All assisted reproductive technology clinics will, as and when such
central facilities are established, put on line all information available to
them in regard to progress of the patient (such as biochemical and
clinical pregnancy) within seven days of the information being
available, withholding the identity of the patient.

(3) Records maintained under sub-section (1) of this section shall be

maintained for at least a period of ten years, upon the expiry of which

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 the assisted reproductive technology clinic shall transfer the records to
a central database of the Indian Council of Medical Research.

(4) In the event of the closure of any assisted reproductive technology

clinic or semen bank before the expiry of the period of ten years under
sub-section (2) of this section, the assisted reproductive technology
clinic or semen bank shall immediately transfer the records to a central
database of the Indian Council of Medical Research.

23. Duties of assisted reproductive technology clinics using gametes and

embryos

(1) Assisted reproductive technology clinics shall harvest oocytes in

accordance with such regulations of the National Board or concerned
State Board or any rule as may be prescribed under this Act.

(2) The number of oocytes or embryos that may be placed in a woman in

any one cycle shall be according to the rules and regulations provided
under this Act.

(3) No woman should be treated with gametes or embryos derived from

the gametes of more than one man or woman during any one
treatment cycle.

(4) The ART clinic shall never mix semen from two individuals before use.

(5) Where a multiple pregnancy occurs as a result of assisted reproductive

technology, the concerned assisted reproductive technology clinic shall
inform the patient immediately of the multiple pregnancy and its
medical implications and shall, if so instructed by the patient, carry out
foetal reduction.

(6) The collection of gametes from a person whose death is imminent shall
only be permissible if such persons spouse intends to avail assisted
reproductive technology to have a child.

(7) No assisted reproductive technology clinic shall use ova that are
derived from a foetus, in any process of in vitro fertilisation.

(8) No assisted reproductive technology clinic shall utilise any semen,

whether from a semen bank or otherwise, for any aspect of assisted
reproductive technology unless such semen is medically analysed in
such manner as may be prescribed.

(9) Any contravention of stipulation under sub-section 3, 4, 7 and 8 of this

section shall amount to an offence under this Act.

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24. Pre-implantation Genetic Diagnosis

(1) Pre-implantation Genetic Diagnosis shall be used only to screen the

embryo for known, pre-existing, heritable or genetic diseases or as
specified by the Registration Authority.

(2) Destruction or donation (with the approval of the patient) to an

approved research laboratory for research purposes, of an embryo
after Pre-implantation Genetic Diagnosis, shall be done only when the
embryo suffers from pre-existing, heritable, life-threatening or genetic
diseases

(3) The State Board may lay down such other conditions as it deems fit in
the interests of Pre-implantation Genetic Diagnosis.

25. Sex selection

(1) No assisted reproductive technology clinic shall offer to provide a

couple with a child of a pre-determined sex.

(2) It shall be a criminal offence and it is prohibited for anyone to do any

act, at any stage, to determine the sex of the child to be born through
the process of assisted reproductive technology.

(3) No person shall knowingly provide, prescribe or administer any thing

that would ensure or increase the probability that an embryo shall be of
a particular sex, or that would identify the sex of an in vitro embryo,
except to diagnose, prevent or treat a sex-linked disorder or disease.

(4) No assisted reproductive technology clinic will carry out any assisted
reproductive technology procedure to separate, or yield fractions
enriched in sperm of X or Y variations.

(5) Any contravention of stipulation under sub-section 1, 2, 3 and 4 of this

section shall amount to an offence under this Act.

19
 CHAPTER - V

SOURCING, STORAGE, HANDLING AND RECORD KEEPING FOR

GAMETES, EMBRYOS AND SURROGATES

26. Sourcing of gametes

(1) The collection, screening, storage and handling of gametes shall be

done by a semen bank registered as an independent entity under the
provisions of this Act.

(2) A semen bank shall operate independently of any assisted

reproductive technology clinic.

(3) Semen banks shall obtain semen from males between twenty one
years of age and forty five years of age, both inclusive, and arrange to
obtain oocytes from females between twenty one years of age and
thirty five years of age, both inclusive, and examine the donors for such
diseases, sexually transmitted or otherwise, as may be prescribed, and
all other communicable diseases which may endanger the health of the
parents, or any one of them, surrogate or child.

(4) All semen banks shall have standard, scientifically established facilities
and defined standard operating procedures for the cryo-preservation of
sperm and oocytes.

(5) All semen banks shall cryo-preserve sperm donations for a quarantine
period of at least six months before being used and, at the expiry of
such period, the semen bank shall not supply the sperm to any
assisted reproductive technology clinic unless the sperm donor is
tested for such diseases, sexually transmitted or otherwise, as may be
prescribed.

(6) A semen bank may advertise for gamete donors and surrogates, who
may be compensated financially by the bank.

(7) A semen bank shall not supply the sperm of a single donor for use
more than seventy five times.

(8) No woman shall donate oocytes more than six times in her life, with not
less than a three-months interval between the oocyte pick-ups.

(9) If more than fourteen (14) oocytes are retrieved from the donor at one
occasion, they shall not be used for more than two recipients thus
ensuring that at least seven oocytes are available for each recipient.

(10) One sample of semen supplied by a semen bank shall be used by the
ART clinic only once on only one recipient.

20
 (11) A semen bank shall obtain all necessary information in respect of a
sperm or oocyte donor or a surrogate, including the name, identity and
address of such donor or surrogate, in such manner as may be
prescribed, and shall undertake in writing to the donor to keep such
information confidential.

(12) No semen bank shall divulge the name, identity or address of any
sperm donor to any person or assisted reproductive technology clinic
except in pursuance of an order or decree of a court of competent
jurisdiction.

(13) Any person or semen bank who divulges the name, identity or address
of a sperm donor in contravention of subsections 11 and 12 of this
section shall be guilty of an offence under this Act.

(14) A semen bank may, for such appropriate fee as may be prescribed,
store any semen obtained from a donor for the exclusive use of the
wife or partner of the donor.

27. Storage and handling of gametes and embryos

(1) The highest possible standards should be followed in the storage and
handling of gametes and embryos in respect of their security, and with
regard to their recording and identification.

(2) No gamete shall be stored for a period of more than ten years.

(3) An embryo may, for such appropriate fee as may be prescribed, be

stored for a maximum period of five years and at the end of such
period such embryo shall be allowed to perish or donated to an
approved research organization for research purposes with the consent
of the patients.

Provided that where the persons to whom such embryo relates fails to
pay the fee, the assisted reproductive technology clinic may, subject to
such regulations as may be prescribed, destroy the embryo or transfer
the embryo to any accredited research organisation under section 13 of
this Act.

28. Records to be maintained by semen bank

(1) The semen bank shall keep a record of all the gametes received,
stored and supplied, and details of the use of the gametes of each
donor.

(2) The records shall be maintained for at least ten years, after which the
records shall be transferred to a central database of the Indian Council
of Medical Research.

21
 (3) Where an assisted reproductive technology clinic closes before the
expiry of the ten year period, the records shall be immediately
transferred to the central database of the Indian Council of Medical
Research.

(4) If not otherwise ordered by a court of competent jurisdiction, all semen

banks shall ensure that all information about clients and donors is kept
confidential and that information about gamete donation shall not be
disclosed to anyone other than the central database of the Indian
Council of Medical Research.

29. Restriction on sale of gametes, zygotes and embryos

(1) The sale, transfer or use of gametes, zygotes and embryos, or any part
thereof or information related thereto, directly or indirectly to any party
outside India is prohibited and shall be deemed to be an offence under
this Act except in the case of transfer of own gametes and embryos for
personal use with the permission of the National Board.

(2) The sale of gametes, except for use by an assisted reproductive

technology clinic for treating infertility, and the sale of zygotes and
embryos, or of any information related to gametes, zygotes or
embryos, within India, is prohibited and shall be deemed to be an
offence under this Act.

22
 CHAPTER - VI

REGULATION OF RESEARCH ON EMBRYOS

30. Permission of the Indian Council of Medical Research (ICMR) for research

(1) The sale of any gametes and embryos for research or their transfer to
any country outside India, is absolutely prohibited and shall constitute a
criminal offence under this Act.

(2) Research shall only be conducted on such gametes and embryos that
have been donated for such purpose.

(3) No research shall be conducted using embryos except with the

permission of the ICMR.

(4) Any person or organisation, by whatsoever name called, may apply to

the ICMR for registration as a research institution permitted to conduct
research on embryos.

(5) While granting permission on an application for registration made

under sub-section 4 of this section, the ICMR may prescribe, and the
applicant shall be bound by such terms and conditions as it thinks fit.

(6) The ICMR may, if it has reasonable grounds to believe that any of the
terms and conditions prescribed under sub-section 5 of this section
have not been met,

(a) call for the production of such documents or the furnishing of

such evidence as may be required;

(b) inspect, or order any officer authorised in this behalf to inspect,

any premises related to the grant of registration;

(c) suspend the registration of the research institution, after giving

all concerned parties adequate opportunity to be heard.

(7) The ICMR may make such regulations as it thinks fit to provide for
research on embryos.

(8) Any act or thing done or omitted to be done in contravention of the

provisions of this Chapter shall be deemed to be an offence under this
Act.

31. Regulation of research

(1) In exercising its powers under this Chapter, the ICMR shall ensure that

(a) no research is conducted on any human embryo unless such

research is necessary in public interest;

23
 (b) no research is conducted on any human embryo created in vitro
unless such research is necessary in public interest to acquire
further scientific knowledge;

(c) no research is conducted on any human embryo, other than

embryos given for storage to a semen bank under sub-section
(3) of section 27, unless full and informed consent in writing is
obtained from the persons from whom such embryo was
created;

(d) no advertisement is issued, and no purchase, sale or transfer is

made, of any human embryo created in vitro or any part thereof,
except in accordance with this Act;

(e) no human embryo created in vitro is maintained for a period

exceeding fourteen days or such other period as recommended
by the National Advisory Board;

(f) no work is done leading to human reproductive cloning;

(g) such other terms and conditions that may be prescribed by the
ICMR, are adhered to.

(2) Any assisted reproductive technology clinic or other research institution

or person conducting any research in contravention of the provisions of
this Act or any rules or regulations prescribed hereunder shall be an
offence under this Act.

24
 CHAPTER - VII

RIGHTS AND DUTIES OF PATIENTS, DONORS, SURROGATES AND

CHILDREN

32. Rights and duties of patients

(1) Subject to the provisions of this Act and the rules and regulations made
thereunder, ART shall be available to all persons including single
persons, married couples and unmarried couples.

(2) In case ART is used by a married or unmarried couple, there must be

informed consent from both the parties.

(3) The parents of a minor child have the right to access information about
the donor, other than the name, identity or address of the donor, or the
surrogate mother, when and to the extent necessary for the welfare of
the child.

(4) All information about the patients shall be kept confidential and
information about ART procedures done on them shall not be disclosed
to anyone other than the central depository of the ICMR, except with
the consent of the person or persons to whom the information relates,
or by a court order.

33. Rights and duties of donors

(1) Subject to the other provisions of this Act, all information about the
donors shall be kept confidential and information about gamete
donation shall not be disclosed to anyone other than the central
database of the Indian Council of Medical Research, except with the
consent of the person or persons to whom the information relates, or
by an order of a court of competent jurisdiction.

(2) Subject to the other provisions of this Act, the donor shall have the right
to decide what information may be passed on and to whom, except in
the case of an order of a court of competent jurisdiction.

(3) A donor shall relinquish all parental rights over the child which may be
conceived from his or her gamete.

(4) No assisted reproductive technology procedure shall be conducted on

or in relation to any gamete of a donor under this Act unless such
donor has obtained the consent in writing of his or her spouse, if there,
to such procedure.

25
34. Rights and duties in relation to surrogacy

(1) Both the couple or individual seeking surrogacy through the use of
assisted reproductive technology, and the surrogate mother, shall enter
into a surrogacy agreement which shall be legally enforceable.

(2) All expenses, including those related to insurance, of the surrogate

related to a pregnancy achieved in furtherance of assisted reproductive
technology shall, during the period of pregnancy and after delivery as
per medical advice, and till the child is ready to be delivered as per
medical advice, to the biological parent or parents, shall be borne by
the couple or individual seeking surrogacy.

(3) Notwithstanding anything contained in sub-section (2) of this section

and subject to the surrogacy agreement, the surrogate mother may
also receive monetary compensation from the couple or individual, as
the case may be, for agreeing to act as such surrogate.

(4) A surrogate mother shall relinquish all parental rights over the child.

(5) No woman under twenty one years of age and over forty five years of
age shall be eligible to act as a surrogate mother under this Act.

Provided that no woman shall act as a surrogate for more than three
successful live births in her life.

(6) Any woman seeking or agreeing to act as a surrogate mother shall be

medically tested for such diseases, sexually transmitted or otherwise,
as may be prescribed, and all other communicable diseases which may
endanger the health of the child, and must declare in writing that she
has not undergone intravenous medical treatment or received a blood
transfusion.

(7) Individuals or couples may obtain the service of a surrogate through a

semen bank, or advertise to seek surrogacy provided that no such
advertisement shall contain any details relating to the caste, ethnic
identity or descent of any of the parties involved in such surrogacy. No
assisted reproductive technology clinic shall advertise to seek
surrogacy for its clients.

(8) A surrogate mother shall, in respect of all medical treatments or

procedures in relation to the concerned child, register at the hospital or
such medical facility in her own name, clearly declare herself to be a
surrogate mother, and provide the name or names and addresses of
the person or persons, as the case may be, for whom she is acting as
a surrogate, along with a copy of the certificate mentioned in clause 17
below.

26
(9) If the first embryo transfer has failed in a surrogate mother, she may, if
she wishes, decide to accept on mutually agreed financial terms, at
most two more successful embryo transfers for the same couple that
had engaged her services in the first instance. No surrogate mother
shall undergo embryo transfer more than three times for the same
couple.

(10) The birth certificate issued in respect of a baby born through surrogacy
shall bear the name(s) of the genetic parents / parent of the baby.

(11) The person or persons who have availed of the services of a surrogate
mother shall be legally bound to accept the custody of the child /
children irrespective of any abnormality that the child / children may
have, and the refusal to do so shall constitute an offence under this
Act.

(12) Subject to the provisions of this Act, all information about the surrogate
shall be kept confidential and information about the surrogacy shall not
be disclosed to anyone other than the central database of the Indian
Council of Medical Research, except by an order of a court of
competent jurisdiction.

(13) A surrogate mother shall not act as an oocyte donor for the couple or
individual, as the case may be, seeking surrogacy.

(14) No assisted reproductive technology clinic shall provide information on

or about surrogate mothers or potential surrogate mothers to any
person.

(15) Any assisted reproductive technology clinic acting in contravention of

sub-section 14 of this section shall be deemed to have committed an
offence under this Act.

(16) In the event that the woman intending to be a surrogate is married, the
consent of her spouse shall be required before she may act as such
surrogate.

(17) A surrogate mother shall be given a certificate by the person or

persons who have availed of her services, stating unambiguously that
she has acted as a surrogate for them.

(18) A relative, a known person, as well as a person unknown to the couple

may act as a surrogate mother for the couple. In the case of a relative
acting as a surrogate, the relative should belong to the same
generation as the women desiring the surrogate.

(19) A foreigner or foreign couple not resident in India, or a non-resident

Indian individual or couple, seeking surrogacy in India shall appoint a
local guardian who will be legally responsible for taking care of the
surrogate during and after the pregnancy as per clause 34.2, till the

27
 child / children are delivered to the foreigner or foreign couple or the
local guardian. Further, the party seeking the surrogacy must ensure
and establish to the ART clinic through proper documentation that the
party would be able to take the child / children born through surrogacy,
including where the embryo was a consequence of donation of an
oocyte or sperm, outside of India to the country of the partys origin or
residence as the case may be.

(20) A couple or an individual shall not have the service of more than one
surrogate at any given time.

(21) A couple shall not have simultaneous transfer of embryos in the

woman and in a surrogate.

35. Determination of status of the child

(1) A child born to a married couple through the use of assisted

reproductive technology shall be presumed to be the legitimate child of
the couple, having been born in wedlock and with the consent of both
spouses, and shall have identical legal rights as a legitimate child born
through sexual intercourse.

(2) A child born to an unmarried couple through the use of assisted

reproductive technology, with the consent of both the parties, shall be
the legitimate child of both parties.

(3) In the case of a single woman the child will be the legitimate child of
the woman, and in the case of a single man the child will be the
legitimate child of the man.

(4) In case a married or unmarried couple separates or gets divorced, as

the case may be, after both parties consented to the assisted
reproductive technology treatment but before the child is born, the child
shall be the legitimate child of the couple.

(5) A child born to a woman artificially inseminated with the stored sperm
of her dead husband shall be considered as the legitimate child of the
couple.

(6) If a donated ovum contains ooplasm from another donor ovum, both
the donors shall be medically tested for such diseases, sexually
transmitted or otherwise, as may be prescribed, and all other
communicable diseases which may endanger the health of the child,
and the donor of both the ooplasm and the ovum shall relinquish all
parental rights in relation to such child.

(7) The birth certificate of a child born through the use of assisted
reproductive technology shall contain the name or names of the parent
or parents, as the case may be, who sought such use.

28
36. Right of the child to information about donors or surrogates

(1) A child may, upon reaching the age of 18, apply for any information,
excluding personal identification, relating to his / her genetic parent or
parents or surrogate mother.

(2) The legal guardian of a minor child may apply for any information,
excluding personal identification, about his / her genetic parent or
parents or surrogate mother when required, and to the extent
necessary, for the welfare of the child.

(3) Personal identification of the genetic parent or parents or surrogate

mother may be released only in cases of life threatening medical
conditions which require physical testing or samples of the genetic
parent or parents or surrogate mother.

Provided that such personal identification will not be released without

the prior informed consent of the genetic parent or parents or surrogate
mother.

29
 CHAPTER - VIII

OFFENCES AND PENALTIES

37. Prohibition of advertisement relating to pre-natal determination of sex

and punishment for contravention

(1) No assisted reproductive technology clinic shall issue or cause to be

issued any advertisement in any manner regarding facilities of pre-
natal determination of sex.

(2) No assisted reproductive technology clinic, or agent thereof, shall

publish or distribute or cause to be published or distributed any
advertisement in any manner regarding facilities of pre-natal
determination of sex.

(3) Any person who contravenes the provisions of this section shall be
punishable with imprisonment for a term which may extend to five
years and with fine which may be specified.

Explanation - For the purposes of this section, advertisement includes

any notice, circular, label wrapper or other document and also includes
any visible representation made by means of any light, sound, smoke
or gas.

38. Offences and penalties

(1) Any medical geneticist, gynaecologist, registered medical practitioner

or any person who owns or operates any assisted reproductive
technology clinic, or is employed in such a facility and renders his
professional or technical services to such facility, whether on an
honorary basis or otherwise, and who contravenes any of the
provisions of this Act or rules made thereunder, shall be punishable
with imprisonment for a term which may extend to three years and with
fine which may be specified, and on any subsequent conviction, with
imprisonment which may extend to five years and with fine which may
be specified.

(2) The name of the registered medical practitioner who has been
convicted by the court under sub-section 1 of this section shall be
reported by the State Board to the respective State Medical Council for
taking necessary action including the removal of his name from the
register or the Council for a period of two years for the first offence and
permanently for any subsequent offence.

(3) Any person who seeks the aid of assisted reproductive technology or of
a medical geneticist, gynaecologist or registered medical practitioner
for conducting pre-natal diagnostic techniques on any pregnant woman
for purposes other than those specified in clause (2) of section 4 of the
Pre-natal Diagnostic Techniques (Regulation and Prevention of

30
 Misuse) Act, 1994 [Act 57 of 1994], shall be punishable with
imprisonment for a term which may extend to three years and with fine
which may be specified, and on any subsequent conviction with
imprisonment which may extend to five years and with fine which may
be specified.

(4) The transfer of a human embryo into a male person or into an animal
that is not of the human species shall be an offence under this Act and
shall be punishable with imprisonment for a term which may extend to
three years and with fine which may be specified.

(5) The sale of any embryo for research is absolutely prohibited and shall
be an offence under this Act punishable by imprisonment for a term
which may extend to three years and with fine which may be specified.

39. Presumption in the case of conduct of pre-natal diagnostic techniques

Notwithstanding anything in the Indian Evidence Act, 1872, the court shall
presume, unless the contrary is proved, that the pregnant woman has been
compelled by her husband or the relative to undergo pre-natal diagnostic
technique.

40. Penalty for contravention of the provisions of the Act or rules for which
no specific punishment is provided Whoever contravenes any of the
provisions of this Act or any rules made thereunder, for which no penalty has
been elsewhere provided in this Act, shall be punishable with imprisonment
for a term which may extend to three years, or with fine which may be
specified, or with both, and in the case of continuing contravention, with an
additional fine which may be specified.

41. Offences by companies

(1) Where any offence, punishable under this Act has been committed by
a company, every person who at the time the offence was committed
was in charge of, and was responsible to, the company for the conduct
of the business of the company, as well as the company, shall be
deemed to be guilty of the offence and shall be liable to be proceeded
against and punished accordingly:

Provided that nothing contained in this sub-section shall render any

such person liable to any punishment, if he proves that the offence was
committed without his knowledge or that he had exercised all due
diligence to prevent the commission of such offence.

(2) Notwithstanding anything contained in sub-section (1) of this section,

where any offence punishable under this Act has been committed by a
company and it is proved that the offence has been committed with the
consent or connivance of, or is attributable to any neglect on the part
of, any director, manager, secretary or other officer of the company,
such director, manager, secretary or other officer shall also be deemed

31
 to be guilty of that offence and shall be liable to be proceeded against
and punished accordingly.

Explanation For the purposes of this section,

(a) company means any body corporate and includes a firm or

other association of individuals, and

(b) director, in relation to a firm, means a partner in the firm.

42. Offence to be cognizable, non-bailable and non-compoundable Every

offence under this Act shall be cognizable, non-bailable and non-
compoundable.

32
 CHAPTER - IX

MISCELLANEOUS

43. Maintenance of records

(1) All records, charts, forms, reports, consent letters and all other
documents required to be maintained under this Act and the rules shall
be preserved for a period of ten years or for such period as may be
prescribed

Provided that, if any criminal or other proceedings are instituted against

any facility using assisted reproductive technology, the records and all
other documents of such facility shall be preserved till the final disposal
of such proceedings.

(2) All such records shall, at all reasonable times, be made available for
inspection to the concerned State Board or to any other person
authorised by the concerned State Board in this behalf.

44. Power to search and seize records etc.

(1) If the State Board has reason to believe that an offence under this Act
has been or is being committed at any facility using assisted
reproductive technology, such Board or any officer authorised thereof
in this behalf may, subject to such rules as may be prescribed, enter
and search at all reasonable times with such assistance, if any, as
such authority or officer considers necessary, such facility, and
examine any record, register, document, book, pamphlet,
advertisement or any other material object found therein and seize the
same if the State Board or officer has reason to believe that it may
furnish evidence of the commission of an offence punishable under this
Act.

(2) The provisions of the Code of Criminal Procedure, 1973, relating to

searches and seizures shall, so far as may be, apply to every search or
seizure made under this Act.

45. Power to remove difficulties

(1) If any difficulty arises in giving effect to the provisions of this Act, the
Central Government may, by order published in the Official Gazette,
make such provisions not inconsistent with the provisions of this Act as
may appear to be necessary for removing the difficulty:

Provided that no order shall be made under this section after the expiry
of three years from the commencement of this Act.

(2) Every order made under this section shall be laid, as soon as may be
after it is made, before each House of Parliament.

33
46. Protection of action taken in good faith No suit, prosecution or other legal
proceeding shall lie against the Central or the State Government or the
National Board or State Boards or Registration Authority or any officer
authorised by any of them, for anything which is in good faith done or
intended to be done in pursuance of the provisions of this Act.

47. Power to make regulations The National Advisory Board may, with the
previous sanction of the Central Government, by notification in the Official
Gazette, make regulations not inconsistent with the provisions of this Act and
the rules made thereunder, to provide for

(a) the time and place of the meetings of the Board and the procedure to
be followed for the transaction of business at such meetings, and the
number of members which shall form the quorum;

(b) the conditions for the sale, transfer or hire of embryos and gametes to
research institutions;

(c) regulation of Pre-implantation Genetic Diagnosis;

(d) research on embryos;

(e) the efficient conduct of the affairs of the Board;

(f) any other purpose that may be prescribed.

48. Power of the Central Government to make rules

(1) The Central Government may make rules for carrying out the
provisions of this Act.

(2) In particular, and without prejudice to the generality of the foregoing

power, such rules may provide for

(a) categories of assisted reproductive technology clinics;

(b) the minimum requirements regarding staff in assisted

reproductive technology clinics;

(c) the minimum physical infrastructure requirements for an

assisted reproductive technology clinic;

(d) the various assisted reproductive technology procedures to be

adopted by an assisted reproductive technology clinic;

(e) the criteria for selecting patients for an assisted reproductive

technology procedure;

34
 (f) the criteria for selecting an assisted reproductive technology
procedure for a patient;

(g) information and advise to, and counselling of patient;

(h) the eligibility of couples and individuals to use assisted

reproductive technology;

(i) the eligibility of donors;

(j) the eligibility of surrogate mothers;

(k) the number of embryos that can be implanted in a woman;

(l) the number of times that a patient can be given a procedure;

(m) the maintenance of records;

(n) procedure to search and seize;

(o) the criteria to be fulfilled for a license;

(p) the effective implementation of the Act.

(3) Every rule made by the Central Government under sub-section (1) of
this section shall be laid, as soon as may be after it is made, before
each House of Parliament, while it is in session, for a total period of
thirty days which may be comprised in one session or in two or more
successive sessions, and if, before the expiry of the session
immediately following the session or the successive sessions
aforesaid, both Houses agree in making any modification in the rule or
regulation or both Houses agree that the rule or regulation should not
be made, the rule or regulation shall thereafter have effect only in such
modified form or be of no effect, as the case may be; so, however, that
any such modification or annulment shall be without prejudice to the
validity of anything previously done under that rule or regulation.

49. Power of State Government to make rules Subject to the provisions of

this Act and the rules and regulations made thereunder, the State
Government may make rules to carry out the purposes of this Act.

50. Act to have effect in addition to other Acts The provisions of this Act
shall be in addition to, and not in derogation of, the provisions of any other
law, for the time being in force.

35
36
 The
Assisted Reproductive Technology
(Regulation) Rules - 2008

37
38
 The Assisted Reproductive Technology (Regulation) Rules, 2008

1. Short Title and Commencement

(1) These rules may be called the Assisted Reproductive Technology

(Regulation) Rules, 2008.

(2) They shall come into force on the date of their publication in the Official
Gazette.

2. Definition

In these rules, unless the context otherwise requires:

(a) Act means the Assisted Reproductive Technology (Regulation) Act,

2008;
(b) form means a form appended to these rules;
(c) section means a section of the Act;
(d) Words and expression used herein and not defined in these rules but
defined in the Act, shall have the meaning, respectively, assigned to
them in the Act;
(e) ART means Assisted Reproductive Technology;
(f) Infertility clinics or ART clinics mean all clinics treating infertility.
(g) Infertility clinics mean ART clinics and ART clinics mean Infertility
clinics.

3. Categories of Infertility / ART Clinics

(1) The categories of infertility / ART clinics i.e. Primary (Level 1A),
Primary (Level 1B), Secondary (Level 2) and Tertiary (Level 3) Infertility
/ ART Clinics shall be as specified in Schedule I, Part 1.

(2) Wherever an Institute, Hospital, Nursing Home or any place by

whatever name called, provides Infertility / ART services, it shall
conform to the requirements as specified in Schedule I, Part-1.

4. Minimum Requirement Regarding Staff in Infertility Clinics

Minimum requirement of staff and their qualification for various types of

infertility clinics shall conform to the requirement as specified in Schedule I,
Part-2.

5. Minimum Physical Infrastructure Requirement for an Infertility Clinic

Minimum physical infrastructure for infertility clinics shall conform to the

requirement as specified in Schedule I, Part-3.

39
6. ART Procedures

The various ART procedures that have been widely tested and proven to be
satisfactory have been specified in Schedule I, Part-4. The ART procedures
adopted by the infertility clinic shall conform to the procedures as specified in
Schedule I, Part-4.

7. Patient Selection

The criteria for patient selection in order to categorize them in specified

groups for referral to different levels of infertility / ART clinics shall conform to
the requirement as specified in Schedule I, Part-5.

8. Selection Criteria for ART Procedure

The choice of the procedure to be used shall depend upon the need,
resources and circumstances of the individual couple, availability of the
facilities, and experience and expertise of the Gynaecologist / Embryologist.
The selection criteria for various ART procedures shall conform to the
requirement as specified in Schedule I, Part-6.

9. Information, Advice and Counselling to Patients

Information, advice and counselling to be given to the patient shall conform to

the requirement as specified in Schedule I, Part-7.

10. Registration of ART Clinics, Semen Banks and Research Centres using
Human Embryos

(1) An application for registration shall be made by the above to the State
Registration Authority in duplicate, in Forms A, A1 and A2,
respectively.

(2) The Registration Authority, or any person in its office authorized in this
behalf, shall acknowledge receipt of the application for registration, in
the acknowledgement slip provided at the bottom of the Form,
immediately after delivery at the office of the Appropriate Authority or
not later than the next working day if received by post.

11. Application Fee

(1) Every application for registration under Rule 10 shall be accompanied

by an application fee to be prescribed by the State Government.

(2) The application fee shall be paid by a demand draft drawn in favour of
the Registration Authority, on any scheduled bank located at the
headquarters of the Registration Authority. The fees collected under
Sub-rule (1), shall be deposited by the Registration Authority
concerned in a bank account opened in the name of the official
designation of the Registration Authority concerned and shall be

40
 utilized by the Registration Authority for activities connected with the
implementation of the provisions of the Act and these rules.

12. Certificate of Registration

(1) The Registration Authority shall, after making such enquiry and after
satisfying itself that the applicant has complied with all the
requirements, send a certificate of registration, in duplicate, in Form B
to the applicant. One copy of the certificate of registration shall be
displayed by the registered ART clinic at a conspicuous place at its
place of business.

(2) If, after enquiry and after giving an opportunity of being heard to the
applicant, the Registration Authority is satisfied that the applicant has
not complied with the requirements of the Act and these rules, it shall,
for reasons to be recorded in writing, reject the application for
registration and communicate such rejection of the applicant along with
the reasons, as specified in Form C.

(3) In such a case, the applicant would have the right to appeal to the
State Board against the decision of the Registration Authority, stating
clearly the reasons for making the appeal, within 30 days of receiving
the decision of the Registration Authority. The State Board should take
a view on the appeal within 60 days of its receipt.

(4) An enquiry under Sub-rule (1) including inspection at the premises of

ART clinic shall be carried out only after due notice is given to the
applicant by the Registration Authority.

(5) Grant of certificate of registration or rejection of application for

registration shall be communicated to the applicant in form B or form C
as the case may be, within a period of 60 days from the date of receipt
of application for registration in the case of clinics in operation on the
date of notification of these rules, and 120 days in the case of clinics
starting operation after the above notification. If no communication is
received from the Registration Authority within the above period, the
ART clinic would deem to have been cleared for registration.

(6) The certification of registration, shall be non-transferable. In the event

of change of ownership or on ceasing to function as an ART clinic, both
copies of the registration shall be surrendered to the Registration
Authority.

(7) In the event of change of ownership of the ART clinic, the new owner of
such clinic shall apply afresh for grant of certificate of registration.

13. Validity of Registration

Every certificate of registration shall be valid for a period of three years from
the date of issue.

41
14. Renewal of Registration

(1) An application for renewal of certificate of registration shall be made in

duplicate in Form A, to the Registration Authority 60 days before the
date of expiry of the certificate of registration. Acknowledgement of the
receipt of such application shall be issued by the Registration Authority
in the manner specified in Sub-rule (2) of Rule 10.

(2) The Registration Authority shall, after holding an enquiry and after
satisfying itself that the applicant has complied with all the
requirements of the Act and these rules, renew the certificate of
registration, as specified in Form B, for a further period of three years
from the date of expiry of the certificate of registration earlier granted.

(3) If, after enquiry and after giving an opportunity of being heard to the
applicant, the Registration Authority is satisfied that the applicant has
not complied with the minimum requirement of the Act and these rules
itself, it shall, for reasons to be recorded in writing, reject the
application for renewal of certificate of registration and communicate
such rejection to the applicant as specified in Form C.

(4) In such a case, the applicant would have the right to appeal to the
State Board against the decision of the Registration Authority, stating
clearly the reasons for making the appeal, within 30 days of receiving
the decision of the Registration Authority. The State Board should take
a view on the appeal within 60 days of its receipt.

(5) The State Government shall prescribe the fee for renewal of certificate
of registration.

(6) On receipt of the renewal of the certificate of registration in duplicate,

or on receipt of communication of rejection of the application for
renewal, both copies of the earlier certificate of registration shall be
surrendered immediately to the Registration Authority by the ART
clinic.

(7) In the event of failure of the Registration Authority to renew the

certificate of registration or to communicate rejection of application for
renewal of registration within a period of 60 days from the date of
receipt of application for renewal of registration, the certificate of
registration shall be deemed to have been renewed for three years.

15. Consents, Agreements and Contracts for Conducting ART Procedures

(1) As prescribed in Section 20 of the Act, the ART clinic shall obtain a
written consent from the couple before conducting any ART procedure,
as specified in Form D, in a language that the couple understands.
The couples written consent for artificial insemination or intrauterine
insemination with husbands semen or sperm shall be taken in Form E.
The couples written consent for artificial insemination or intrauterine

42
 insemination with donor semen or sperm shall be taken in Form F. The
couples written consent for freezing of embryos shall be taken in Form
G. The couples written consent for procedures of PESA and TESA
shall be taken in Form H. The couples written consent for oocyte
retrieval / embryo transfer shall be taken in Form I. Agreement of
surrogacy shall be signed in Form J. Consent for donation of eggs
(oocytes) shall be taken in Form K. Consent for donation of semen /
sperm shall be taken in Form L. Information on semen donor, oocyte
donor and surrogate mother shall be provided on Form M, M1 and M2,
respectively. The results of screening of semen / oocyte donors and
surrogate mothers shall be recorded by the semen bank on Form N.
Records of use of donor gametes and of surrogate mothers, by an
assisted reproductive technology clinic, shall be maintained on Form O.
Oocytes shall be harvested and the records maintained in Form P.
Semen analysis record shall be maintained as in Form Q. Contracts
(including the financial arrangements) between the semen bank on the
one hand, and the semen donor, oocyte donor, surrogate mother,
patient, or the assisted reproductive technology clinic on the other
hand, shall be signed on Form R, R1, R2, S and T, respectively. The
contract (including the financial arrangement) between the patient and
the surrogate shall be signed on Form U. The oath of fidelity and
secrecy by members of the National Advisory Board and the State
Boards, and by others where required, shall be on Form V.

(2) All the State / UT Governments may issue translations of Forms A to V

in languages used in the State / UT. Where no official translation in a
language understood by the couple seeking treatment is available, the
ART Clinic may translate the consent form(s) into a language the
couple understands. In the case of illiterate patients, the Counsellor
will, directly or through an interpreter, and in the presence of a third
party chosen by the patient / couple if so desired by the patient /
couple, read out and explain all the contents of the consent form(s) to
the patient / couple.

(3) No ART clinic shall use a technique on a patient for which expertise
does not exist with the staff of the Clinic.

16. Facilities for Inspection

Every ART clinic shall afford reasonable facilities for inspection of the place,
equipment and records to the Registration Authority or to any other person
authorized by the Registration Authority in this behalf. Such an inspection of
an already registered clinic may take place without any notice, during the
working hours of the clinic.

17. Public Information

At least one copy of the Act and these rules shall be available on the
premises of every ART clinic and shall be made available to the clientele on
demand for perusal.

43
 SCHEDULE I
(See Rules 3, 4, 5, 6, 7, 8 & 9)

PART 1

1. Primary (Level 1A) Infertility Clinics

These clinics will not require registration under the Act. They would be clinics
where preliminary investigations are carried out and type and cause of
infertility diagnosed. Primary infertility care unit or clinics could be a doctors
consulting room, such as a gynaecologists or a physicians consulting room,
or even a general hospital. Depending on the severity of infertility, the couple
could be treated at the Level 1A clinic or referred to a speciality (Level 1B,
Level 2 or Level 3) clinic.

The responsibilities of a Level 1A primary infertility clinic will be:

a) Diligent history taking and basic investigations such as physical

examination and semen analysis.

b) Treatment of minor anatomical defects like imperforate hymen.

c) Treatment of mild endometriosis after confirming its presence by

diagnostic laparoscopy carried out by a competent surgeon with
adequate endoscopic experience.

d) Introduction of ovulation in anovulatory women (especially PCOS) with

drugs such as clomiphene citrate, with or without adjuncts like
bromocriptine, eltroxin, dexamethasone or spironolactone. (Gonadotropin
should not be used at a Level 1A primary infertility clinic.)

e) Correcting minor endocrine disorders such as thyroid disorders or

hyperprolactinemia, by prescribing appropriate corrective medications.

f) Treatment of oligozoospermia.

g) Detecting infection of the reproductive tract using appropriate

diagnostic tests, followed by normal health-care steps after carrying out
appropriate antibiotic sensitivity tests. (Particular care must be taken to
treat the couple and not the female or the male patient alone.)

h) Referral of the couple to Level 1B, Level 2 or Level 3 infertility clinic as

appropriate, specially when the womans age is more than 35, or when
the couple has a multifactorial defect, or when patients with single
treatable defect have not responded to conventional therapy.

44
The gynaecologist or the physician in charge of a Level 1A infertility care unit
should have an appropriate post-graduate degree or diploma, and be capable
of taking care of the above responsibility.

1.1 Primary (Level 1B) Infertility Clinics engaging in artificial

insemination using husbands semen (AIH), artificial insemination
using donor semen (AID) or intrauterine insemination (IUI) using
husbands or donor semen

These clinics will require registration under the Act. They will be
required to have, in addition to what has been stated in para 1 above,
the facilities mentioned in the following two sub-paras (1.1.1 and 1.1.2).
The insemination in such clinics must be done under the supervision of
a gynaecologist with a post-graduate degree.

1.1.1. Facilities for investigations:

a) Immunological tests for infertility, sperm cervical mucous

penetration test (SCMPT), sperm cervical mucous test
(SCMT), and test for antibodies (IgG, IgA) against sperm
antigen in cervical mucous.

b) Sperm function tests such as hypo-osmotic swelling test

(HOST), and assessment for improvement of sperm
motility potential with pentoxifylline co-culture.

c) Assessment of follicular growth and ovulation by serial

ultrasonography.

d) Hysteroscopy, laparoscopy and ultrasonography.

1.1.2. Treatment facilities:

a) Facilities for semen preparation for IUI, including an

appropriate clean room for IUI.

(The facilities for investigation and for semen preparation

mentioned above could be shared with another accredited
infertility clinic or semen bank or an accredited clinical
laboratory.)

1.2 Secondary (Level 2) Infertility Clinics

These clinics will require registration under the Act. They must have
infrastructure for further in-depth investigation and extended treatment
of infertility except where oocytes are handled outside the body. Some
of the investigations and treatment facilities required for Level 2
infertility clinics are mentioned in the following two sub-paras (1.2.1 and
1.2.2).

45
 1.2.1. Facilities for investigations:

a) Immunological tests for infertility, sperm cervical mucous

penetration test (SCMPT), sperm cervical mucous test
(SCMT), and tests for antibodies (IgG, IgA) against sperm
antigen in cervical mucous which can be outsourced to
an accredited clinical laboratory.

b) Sperm function tests like hypo-osmotic swelling test

(HOST), and assessment of the improvement of sperm
motility potential with pentoxifylline co-culture.

c) Assessment of follicular growth and ovulation by serial

transvaginal sonography (TVS).

d) Hysteroscopy, laparoscopy and transvaginal sonography.

1.2.2. Treatment facilities:

a) Facilities for semen preparation and IUI, including an

appropriate clean room for IUI.

b) Provision for semen collection in men with a vibrator or

an electroejaculator in erectile dysfunction and
ejaculatory problems.

c) Conservative surgery either through a laparoscope or

hysteroscope, or via laparotomy.

d) Combined medical-surgical therapy by a co-ordinated

team, for example in endometriosis.

e) Provision for extended treatment of infertility except for

oocyte pick up, in vitro fertilization (IVF), intracytoplasmic
sperm injection (ICSI), and similar techniques

1.3 Tertiary (Level 3) Infertility Clinics

These clinics will require registration and will have three functions to
perform, viz., diagnostic and therapeutic at the highest level of
specialization and with the best of facilities, and research. Some
examples of the first two functions are given below in sub-paras 1.4.1
to 1.4.3. If any of the facilities mentioned below does not exist in the
clinic, the clinic should have access to such a facility in another
appropriately accredited clinic, semen bank, or laboratory.

1.3.1 Diagnostic procedures for male infertility:

a) Endocrine assay.

46
 b) Further tests for sperm function and integrity such as
acrosome reaction and sperm-oocyte interaction in vitro.

c) Assessment of cell contaminants, debris and infection.

d) Karyotyping.

e) Assessment of seminal plasma for viscosity, thinness,

blood contamination and biochemical constituents.

1.3.2 Diagnostic procedures for female infertility:

a) Endocrine assays.

b) Karyotyping.

c) Transvaginal sonography.

1.3.3. Therapeutic procedures:

a) Induction of ovulation using gonadotropin, a GnRH

agonist and antagonist, and other adjuvants.

b) All varieties of assisted reproductive technologies,

including ICSI.

c) Procedures for IUI using split ejaculate, pooled ejaculate

or sperm recovered from post-coital specimen of urine in
retrograde ejaculation.

d) Embryo cryopreservation.

PART 2

2. Minimum Requirement Regarding Staff in Infertility Clinics

The staff requirements given below will be mandatory for Level 2 and Level 3
clinics. In the case of small Level 2 and Level 3 clinics, the services of the
Clinical Embryologist, and / or of the Counsellor, may be shared.

2.1. Gynaecologist

The minimal qualification for a gynaecologist in a Level 2 or Level 3

clinic will be a post-graduate degree in gynaecology. Additional
experience should include:

47
 Understanding of the causative factors of male and female
infertility.

Knowledge of the practice and use of diagnostic methods for

determining the cause of infertility.

Knowledge of the clinical aspects of reproductive endocrinology

and the reproductive defects caused by endocrine factors, and
an understanding of the limitations of the currently used
hormone assay methods, and of the techniques available for
medically or surgically correcting endocrine disorders.

Competence in gynaecological ultrasonography to diagnose

reproductive tract anomalies; monitoring ovarian and uterine
response to ovarian stimulation; picking up oocytes at the most
appropriate time; and transferring embryos by any one of the
several methods currently available to handle embryo transfer in
difficult cases.

The gynaecologist must be knowledgeable about the principles of

ovarian stimulation and the management of complications arising
thereupon.

The responsibilities of the gynaecologist would include the following:

Interviewing of the infertile couple initially.

History taking.
Physical examination of the female.
Recommending appropriate tests to be carried out, interpreting
them and treating medical disorders (such as infections and
endocrine anomalies).
Carrying out gynaecological endoscopy and ultrasonographic
intervention for diagnosis and therapy of infertility.
Carrying out AIH, AID, IUI, in vitro fertilization (IVF) or
intracytoplasmic sperm injection (ICSI), and other ancillary
procedures as the case and facilities may warrant, based on
diagnostic evidence.

For a level 3 clinic, the gynaecologist must also have the expertise of
ovum pick up and embryo transfer.

2.2 Andrologist

Fifty percent of infertility cases are related to male factors, many of

which can be treated by specific ART procedures or other less invasive
procedures. Andrology, a subject related to male reproduction, does
not constitute a formal course in the medical curriculum in India. In

48
India it is the urologist with a post-graduate degree in urology that often
takes on the task of treating male infertility. Such individuals must
receive additional training in diagnosis of various types of male
infertility covering psychogenic impotence, anatomical anomalies of the
penis which disable normal intercourse, endocrine factors that cause
poor semen characteristics and / or impotence, infections, and causes
of erectile dysfunction.

The andrologist must have knowledge of the occupational hazards,

infections and fever that cause reversible or irreversible forms of
infertility, and knowledge of ultrasonographic and vasographic studies
of the male reproductive tract. He / she must also be well-versed in
treating impotence and ejaculatory dysfunction.

He / she must understand the principles of semen analyses and their

value and limitation in diagnosis of male fertility status. The andrologist
must be able to collect semen by prostatic massage for microbial
culture in cases where infection may lie in the upper regions (prostate,
seminal vesicles) of the reproductive tract. He / she should also be
able to collect spermatozoa through surgical sperm retrieval
techniques, and be well-versed in the technique of electro-ejaculation.
He must also be knowledgeable about the genetic implications of using
poor-quality sperm for ICSI. He / she should be familiar with the
surgical procedures available for correcting an anatomical defect in the
reproductive system such as epididymovasal re-anastmosis and
varicocoelectomy.

An individual may act as an andrologist for more than one clinic but
each clinic where the andrologist works must own responsibility for the
andrologist and ensure that the andrologist is able to take care of the
entire work load of the clinic without compromising on the quality of
service.

The responsibilities of the andrologist would include the following:

Recording case histories.

Prescribing appropriate diagnosis and treatment based on the
diagnosis.
Carrying out such surgical procedures as warranted by the
diagnosis.
Maintaining all the records, from the case history to the
treatment given, and the patient consent forms.
Referring the couple to the gynaecologist for carrying out the
appropriate ART procedure if necessary, after the male factor
has been duly investigated.
Referring the couple to the counsellor if necessary.

49
2.3 Clinical Embryologist

The clinical embryologist must be knowledgeable in mammalian

embryology, reproductive endocrinology, genetics, molecular biology,
biochemistry, microbiology and in vitro culture techniques. The
embryologist must also be familiar with ART. He / she must be either a
medical graduate or have a post-graduate degree or a doctorate in an
appropriate area of life sciences. (In the case of a clinic in existence for
at least one year before the promulgation of these rules, a person with
a B.Sc. or B.V.Sc degree but with at least five years of first-hand,
hands-on experience of the techniques mentioned below and of
discharging the responsibilities listed below, would be acceptable for
functioning as a clinical embryologist in the particular clinic. Such
persons would also be eligible to take a test to be designed and
conducted by an appropriate designated authority, to qualify for a
position of a clinical embryologist in a new clinic.) He / she must be
familiar with the following:

Principles and practice of semen analysis and cryopreservation

of semen.
Cytology of mammalian and human oocyte to identify stages of
oocyte maturation accurately.
All aspects of embryology including developmental biology.
Cell biological techniques used in cell and tissue culture.
Molecular biology and genetics of human reproduction.
Micromanipulation of sperm and oocytes for carrying out ICSI
and single-cell biopsies of embryos for preimplantation genetic
diagnosis.
Principles and functioning of all the equipment used in the
laboratory.
In vitro fertilization of oocytes after processing the gametes.
Principles and practice of embryo freezing.

The responsibilities of the clinical embryologist would be:

To ensure that all the necessary equipments are present in the

laboratory and are functional.
To perform all the procedures pertaining to processing, handling
and culturing of gametes and embryos in the laboratory and
hand over the embryo to the gynaecologist.
To maintain records of all the procedures carried out in the
laboratory.

50
 In case of shortage of adequately trained clinical embryologists, an
individual may act as a clinical embryologist for more than one clinic
but each clinic where the person works must own responsibility for the
embryologist and ensure that the embryologist is able to take care of
the entire work load of the clinic without compromising on the quality of
service. An embryologist must not be associated with more than two
centers at any given time.

2.4 Counsellor

A person who has at least a degree (preferably a post-graduate

degree) in Social Sciences, Psychology, Life Sciences or Medicine,
and a good knowledge of the various causes of infertility and its social
and gender implications, and the possibilities offered by the various
treatment modalities, should be considered as qualified to occupy this
position. The person should have a working knowledge of the
psychological stress that would be experienced by potential patients,
and should be able to counsel them to assuage their fears and anxiety
and not to have unreasonable expectations from ART. A member of
the staff of an ART clinic who is not engaged in any other full-time
activity in the clinic can act as a counsellor.

The counsellor must invariably apprise the couple of the advantages of

adoption as against resorting to ART involving a donor. An individual
may act as a counsellor for more than one clinic but each clinic where
the counsellor works must own responsibility for the counsellor and
ensure that the counsellor is able to take care of the entire counselling
load of the clinic without compromising on the quality of the counselling
service.

2.5 Programme Co-ordinator / Director

This should be a senior person who has had considerable experience

in all aspects of ART. The programme co-ordinator / director should be
able to co-ordinate the activities of the rest of the team and ensure that
staff and administrative matters, stock keeping, finance, maintenance
of patient records, statutory requirements, and public relations are
taken care of adequately. He / she should ensure that the staff are
keeping up with the latest developments in their subject, by providing
them with information from the literature, making available to them
access to the latest journals, and encouraging them to participate in
conferences and meetings and present their data. The programme co-
ordinator / director should have a post-graduate degree in an
appropriate medical or biological science. In addition, he / she must
have a reasonable experience of ART.

51
 PART 3

3. Minimal Physical Requirements for an ART Clinic

A well designed ART clinic of Level 2 or Level 3 (Paras 1.3 and 1.4) should
have a non-sterile and a strictly sterile area as detailed below. Some of the
spaces mentioned below could be combined (that is, the same space may be
used for more than one purpose) as long as such a step does not
compromise the quality of service. However, the space provision for the sterile
area cannot be combined with that for the non-sterile area and vice-versa.
For Level 1B infertility care units (para 1.2), a strictly sterile area will not be
required; the space requirement for such a clinic will , however, include a
reception area, a waiting room for the patients, a consulting room for the
gynaecologist, and requirements mentioned under para 3.9, 3.10 and 3.11.

3.1 The non-sterile area

The non-sterile area must include what is listed under paras 3.2 to
3.10.

3.2. A reception and waiting room for patients

3.3 An examination room with privacy

A separate examination room with privacy for interviewing and

examining male and female partners independently is essential.
Adequate measures must be taken to ensure that history taking and
examination are carried out in strict privacy, maintaining the dignity of
the patients. In case a male doctor examines a female patient, there
must always be a female attendant present. The room must be
equipped with an examination table and gynaecological instruments for
examining the female per vaginum, and an appropriate
ultrasonographic machine.

3.4 A general-purpose clinical laboratory

3.5 Store room

A well-stocked store for keeping essential stock of especially those

items that have to be imported, precluding the need to be caught short
in the middle of treatment, is required. Facilities must be available for
storing sterile (media, needles, catheters, Petri dishes and such-like
items) and non-sterile material under refrigerated and non-refrigerated
conditions as appropriate.

3.6 Record room

Record keeping must be computerized so that data is accessible

retrospectively for analysis or when called upon by the supervisory
agency. The data must include essential details of the patients

52
 records, it must contain history of the cause of infertility as diagnosed
earlier, results of new diagnosis if relevant, the treatment option best
suited for the particular patient, the treatment carried out and the
outcome of treatment, and follow-up if any. Any other noteworthy point
such as possible adverse reaction to drugs, must be recorded. The
software must have archival, retrieval and multivariate statistical
analysis capabilities.

3.7 Autoclave room

A separate facility must be available for sterilizing and autoclaving all

surgical items as well as some of those to be used in the in vitro culture
laboratory.

3.8 Steps for vermin proofing

Adequate steps should be taken to make the whole clinic vermin proof,
with suitable traps for preventing insects and other forms of unwanted
creatures entering the clinic. This essential detail should be planned at
an early stage because no pesticide can be used in a fully functional
IVF clinic, as it could be toxic to the gametes and embryos.

3.9 Semen collection room

This must be a well-appointed room with privacy and an appropriate

environment; it should be located in a secluded area close to the
laboratory (see the next sub-section). Such a facility must be available
in-house rather than having the patient collect the sample and bring it
to the laboratory for analysis as, in the latter case, semen quality and
identity is likely to be compromised. Procedures for collection of
semen as described in the WHO Semen Analysis Manual must be
followed with special reference to the type of container used; these
containers must be sterile, maintained at body temperature and non-
toxic. This room must have a washbasin with availability of soap and
clean towels. The room must also have a toilet and must not be used
for any other purpose.

3.10 Semen processing laboratory

There must be a separate room with a laminar air flow for semen
processing, preferably close to the semen collection room. This
laboratory must also have facilities for microscopic examination of post-
coital test smears. Good Laboratory Practice (GLP) guidelines as
defined internationally must be followed. Care must be taken for the
safe disposal of biological waste and other materials (syringes, glass
slides, etc.). Laboratory workers should be immunized against
hepatitis B and tetanus.

53
3.11 Clean room for IUI

There must be a separate clean room with an appropriate table for IUI.

3.12 The sterile area

The sterile area shall house the operation theatre, a room for embryo
transfer and an adjoining embryology laboratory. Entry to the sterile
area must be strictly controlled by an anteroom for changing footwear,
an area for changing into sterile garments and a scrub-station. The
sterile area must be air-conditioned where fresh air filtered through an
approved and appropriate filter system is circulated at ambient
temperature (22-250C).

3.13 The operation theatre

This must be well equipped with facilities for carrying out surgical
endoscopy and transvaginal ovum pick-up. The operation theatre must
be equipped for emergency resuscitative procedures.

3.14 Room for embryo transfer

This room must be in the sterile area and have an examination table on
which the patient can be placed for carrying out the procedure and then
rest undisturbed for a period of time. The operation theatre can be
used for this purpose.

3.15 The embryology laboratory complex

The embryology laboratory must have facilities for control of

temperature and humidity and must have filtered air with an
appropriate number of air exchanges per hour. Walls and floors must
be composed of materials that can be easily washed and disinfected;
use of carpeting must be strictly avoided. The embryology laboratory
must have the following:

A laminar flow bench with a thermostatically controlled heating

plate
A stereo microscope
A routine high-powered binocular light microscope
A high-resolution inverted microscope with phase contrast or
Hoffman optics, preferably with facilities for video recording
A micromanipulator (if ICSI is done)
A CO2 incubator, preferably with a back up
A hot air oven
A laboratory centrifuge
Equipment for freezing embryos in a programmed manner
Liquid nitrogen cans
A refrigerator

54
 Appropriate steps need to be taken for the correct identification of
gametes and embryos to avoid mix-ups. All material from the
operation room, culture dishes and Falcon tubes for sperm
collection (including lids), must bear the name of the patient. In
the incubator, identified oocytes and sperm should be kept together on
the same tray and double-checked. Pipettes used should be disposed
off immediately after use. The embryology laboratory must have daily
logbook in which all the days activities are recorded, including the
performance of the equipment.

3.16 Ancillary laboratory facilities

The infertility clinic need to have in-house facilities to perform all the
procedures necessary to diagnose infertility, such as those mentioned
in the two sub-section that follow. They can be out sourced to
speciality laboratories delivering such services, as long as they are
located in the neighborhood.

3.17 Hormone and other assays

The infertility clinic must have ready access to laboratories that are
able to carry out immunoassays of hormones (FSH, LH, Prolactin,
hCG, TSH, Insulin, Estradiol, Progesterone, Testosterone and DHEA)
and tests such as for HIV and Hepatitis B. Endocrine evaluation
constitutes an essential diagnostic procedure to determine the cause of
infertility. It is also necessary to estimate blood estradiol in samples
taken from a woman undergoing controlled ovarian hyperstimulation,
and have the result on the same day to determine the dose of drugs to
be given for induction of ovulation. Accurate monitoring of endocrine
response to controlled ovarian stimulation goes a long way in
preventing ovarian hyperstimulation.

3.18 Microbiology and histopathology

Another important facility in an ART clinic (or easily accessible to it)

would be that of a microbiology laboratory that can carry out rapid tests
for any infection, and a clinical chemistry laboratory. Facilities for
carrying out hisopathological studies on specimens obtained from the
operation theatre would also be desirable.

3.19 Maintenance of the laboratories

Each laboratory must maintain in writing, standard-operating manuals

for the different procedures carried out in the laboratory. It should be
ensured that there is no mix up of gametes or embryos. The patients
name should be clearly labelled on all the tubes, dishes and pipettes
containing the gametes and embryos. All pipettes should be
immediately discarded after use.

55
 Laminar flowhoods, laboratory tables, incubators and other areas
where sterility is required must be periodically checked for microbial
contamination using standard techniques, and a record of such checks
must be kept.

A log book must be maintained which records the temperature, carbon

dioxide content and humidity of the incubators and the manometer
readings of the laminar air flow.

All instruments must be calibrated periodically (at least once every

year) and a record of such calibration maintained.

3.20 Quality of consumables used in the laboratory

All disposable plasticware must be procured from reliable sources after

ensuring that they are not toxic to the embryo. Culture media used for
processing gametes or growing embryos in vitro should be preferably
procured from reliable manufacturers. Each batch of culture medium
needs to be tested for sterility, endotoxins, osmolality and pH. The
embryologist should know the composition of the media that are being
used. Most media are supplemented with serum; they should,
therefore, be tested for antibodies to HIV 1 and 2, Hepatitis B Surface
Antigen and Hepatitis C RNA.

3.21 Back-up power supply

A power back-up in the form of a UPS system and / or a captive power

generative system must be available in infertility clinics of Level 1B, 2
or 3.

PART 4

4. Assisted Reproductive Technology (ART) Procedures:

A variety of ART procedures have been described in the literature. The

commonly used procedures that have been widely tested and proven to be
satisfactory as of writing this document are listed below. One of the primary
concerns of all ART treatments is the safety of the patients and of their
gametes and embryos which constitute the very beginning of a new
individuals life. The basic tenets of any medical treatment mentioned in the
Helsinki Declaration of 1964 as received from time to time, clearly spell out
the ethical concerns of treating patients. These basic tenets are also
applicable to ART. The clinic must ensure that a particular ART being offered
has been appropriately tested according to the norms of scientific practice, or
if experimental has a sound scientific basis as adjudged by peers, and is
fully in consonance wit the diagnosis made of the cause of infertility. More
particularly, the clinic must make sure that patients are well informed about

56
the treatment being offered to them, the reasons of suggesting a particular
form of treatment, and alternative therapies available if any.

ART clinics in the country should bring to the notice of the National Advisory
Board or a State Board on a continuing basis, any new procedure for the
practice of which there would appear to be a sound scientific case. The
National Advisory Board / State Board or a body appointed by it shall approve
or disapprove the new procedure within six months of its having been made
aware of in writing; if this is not done, the clinic could continue to use the
procedure until the above body has taken a decision on it. No new procedure
that has not been approved as above shall be permitted to be used by an
infertility clinic for more than the period mentioned above. The National
Advisory Board may, on its own initiative, approve a new assisted
reproductive technology procedure.

4.1 Artificial insemination with husbands semen (AIH)

The technique consists of placing the husbands unprocessed semen

inside the vagina.

4.2 Artificial insemination with donor semen (AID)

AID involves placing of donors semen obtained from an accredited

semen bank inside the vagina. The common indications for AID are
when there is (a) non-obstructive azoospermia; (b) the husband has a
hereditary genetic defect; (c) the couple has Rh incompatibility; or (d)
the man has severe oligozoospermia and the couple does not wish to
undergo any of the sophisticated ART such as ICSI.

4.3. Intrauterine insemination with either husbands or donor semen

(IUI-H or IUI-D)

IUI involves the processing of semen in the laboratory so as to yield

pure, active sperm, devoid of seminal plasma, which are then directly
placed into the uterus.

Common indications for IUI are:

Hostile uterine cervix.

Oligozoospermia

Unexplained infertility

4.4. In vitro fertilization and embryo transfer (IVF-ET)

The technique of IVF consists of bringing about the fertilization of the

oocyte by the spermatozoa in the laboratory instead of in the womans
fallopian tube. IVF involves controlled ovarian stimulation to obtain
multiple oocytes, followed by appropriate monitoring at the appropriate

57
 moment of follicular growth, the follicles are aspirated to obtain the
oocytes. The oocytes are mixed with appropriately capacitated
spermatozoa from the husband (or the donor, if the medical condition
indicates the use of donor sperm) and kept in an incubator for
fertilization which is observed microscopically after 16 to 18 hours.
Embryos are transferred into the uterine cavity between days 2 and 6
after oocyte aspiration. If implantation takes place, pregnancy can be
confirmed 14 to 16 days after embryo transfer by determining the
presence of hCG in a blood or urine sample. Such a test is reliable only
when progesterone is used for luteal supplementation instead of hCG.

The original indication for IVF was irreversible pathology of the

fallopian tubes, resulting from an inflammatory process or from
previous surgery. However, in recent years the indications for IVF
include infertility due to a subnormal male factor.

Some other indications are:

Idiopathic infertility.
Endometriosis.
Infertility of immunological origin.

4.5 IVF associated techniques

Gamete Intrafallopian Tube Transfer (GIFT) or Tubal Embryo Transfer

(TET) has been recommended for patients with healthy fallopian tubes.
Access to the tube is gained by laparoscopy or by retrograde
catheterization through the uterine cervix.

4.6 Intracytoplasmic sperm injection (ICSI) with ejaculated,

epididymal or testicular spermatozoa

It is well known that the incidence of fertilization with sub-optimal

semen is much lower in contrast to normal semen samples. It has
been argued that since a sizeable number of couples are not suitable
for IVF because of poor sperm parameters, alternate methods must be
found to facilitate fertilization. Several approaches have been
developed to circumvent the barriers (the zona pellucida and the
ooplasmic membrane) that prevent the sperm reaching the ooplasm.
Notable amongst these are: partial zona dissection (PZD), subzonal
insemination (SUZI), and intracytoplasmic sperm injection (ICSI). Live
birth have been reported using all these methods. The use of PZD or
SUZI must be discouraged, as they do not offer any distinct advantage.
ICSI is the most widely accepted choice of treatment for male factor
infertility. ICSI can be carried out with fresh or frozen-thawed
ejaculated or epididymal/testicular motile (live) spermatozoa.

4.6.1 Indications of ICSI with ejaculated spermatozoa

Examples are:

58
 Severe male-factor infertility.
Fertilization failure after standard IVF treatment.
Number of spermatozoa in the ejaculate too low for IVF.

4.6.2 Indications of ICSI with surgically retrieved sperm

(MESA/PESA/TESA/TESE)

Microsurgical Epididymal Sperm Aspiration involves aspiration

of sperm from epididymis under magnification, using
microsurgical principles.

Percutaneous Epididymal Sperm Aspiration (PESA) and

Testicular Sperm Aspiration / Extraction (TESA / TESE) are
simplified, minimally invasive outpatient procedures that allow
the physician to recover the sperm for fertilization in patients
with obstructive azoospermia (lack of sperm in semen).

PESA requires a needle to be introduced percutaneously into

the epididymis and the contents aspirated. The aspirate is
observed under the microscope to determine if motile sperm are
present.

In TESA, the needle is introduced in the testicle itself. In TESE,

the semen-eferous tubules along with the sperm are introduced
surgically.

Examples of indications are:

Congenital bilateral absence of the vas deferens

(CBAVD).
Obstructive azoospermia
Non-obstructive azoospermia
Anejaculation.
Retrograde ejaculation.

4.6.3 Indications of ICSI with in vitro matured oocytes

Polycystic ovary
History of ovarian hyperstimulation syndrome (OHSS)

4.7 Oocyte donation (OD) or embryo donation (ED)

Oocyte donation would involve fertilizing the oocyte(s) of an

anonymous oocyte donor with the husbands sperm and transferring
the resultant embryo into the infertile female partner. Embryo donation
involves transferring of an embryo generated using anonymous oocyte
and sperm donors into the female partner.

59
 4.7.1 Indications for oocyte donation

Examples are:

Gonadal dysgenesis.
Premature ovarian failure.
Iatrogenic ovarian failure due to ovarian surgery or
radiation, or chemical castration.
Women who have resistant ovary syndrome, or who are
poor responders to ovulation induction.
Women who are carriers of recessive autosomal
disorders.
Women who have attained menopause.

Donors should be healthy (as determined by medical and

psychological examination, screening for STDs, and absence of
HIV antibodies) women in the age group of 18-35 years. The
recipient should be a healthy woman (determined by medical
and psychological examination) having normal genitalia (as
determined by physical examination) and uterine cavity (as
determined by hystero-salpingography). In case of OD, the
semen characteristics of the husband must be determined to
see if they are in conformity with those associated with normal
fertility. The blood group of the donor should be noted; the
donor should also be tested for HIV, HBsAg, HCV and VDRL

4.7.2 Indications for embryo donation

This is generally resorted to whom the male partner of a couple

requiring oocyte donation has indications such as:

Primary germ cell failure

Inheritable genetic disorder

4.8 Cryopreservation

Facilities for cryopreservation are an essential component of an ART

Clinic and a semen bank as they are used under a variety of conditions
such as those described below.

4.8.1 Freezing of semen

Men that are likely to suffer from psychological stress at the time
of ovum pick-up or those who cannot be present at the time of
ovum pick-up, are recommended to have their semen frozen for
use at the appropriate time. One of the important reasons for
freezing semen from donors is that any donor semen has to be
quarantined for six months. The safety of using frozen sperm
has been abundantly proven, both by experimental work and the
actual results in humans. Matters of concern are the donors

60
 health and necessity to avoid donors who are infected of with
venereal diseases, hepatitis B or C, or HIV. One of the
drawbacks of sperm freezing is the likelihood of an
approximately 20% loss in motility after thawing. Donors whose
semen is frozen for future use are required to report to the
semen bank six months after donation to be checked for HIV
infection / disease status.

4.8.2 Freezing of embryos

Embryos are routinely cryopreserved to enable storage of

supernumerary embryos, as up to a maximum of only three
embryos is allowed for transfer at one time to avoid the risk of
multiple pregnancies. Embryo freezing is a widespread routine
procedure to increase cumulative pregnancy rates. Human
embryos can be successfully cryopreserved at any stage from
zygote to blastocyst, using 1, 2 propanediol (PROH) or
dimethylsulfoxide (DMSO) for zygotes and cleaved embryos,
and glycerol for blastocysts. The formation of ice crystals is of
concern during embryo freezing. Using programmed, slow
freezers reduces this problem considerably, and slow cooling is
the most widely employed method. Human embryos are known
to survive a simple ultra-rapid procedure of fast cooling but there
is not much data on the efficacy of these techniques when used
routinely. Straws or ampoules used for freezing embryos should
be carefully and permanently labeled for identification purpose.
Patients should be fully informed before the treatment cycle on
the procedure of cryopreservation, the risks and, particularly,
what is to be done with their embryos if they do not use them.
They should sign a consent form concerning the agreement for
embryo freezing as well as for the future use of the embryos.
When a serum supplementation is used in the preparation of
freezing and thawing solutions, one must carefully avoid any risk
of viral transmission to the embryo through the serum.

4.8.3 Oocyte cryopreservation

This procedure has the potential of creating oocyte banks. The

oocyte can be thawed at a later date, and used by the patient
herself or for oocyte donation. However, the success rates in
terms of fertilization, pregnancy and live births with the use of
cryopreserved oocytes have yet to be firmed up. Much remains
to be learnt on identifying the optimal stage of oocyte
development when cryopreservation would be of value.

4.8.4 Ovarian tissue cryopreservation

Although this technique is yet in its infancy, it has the potential

for young women with conditions such as malignancy or severe
endometriosis.

61
 4.9 In vitro culture media

There has been a spurt of new media introduced for in vitro culture of
gametes and embryos. If one takes a close look at these media, they
are products that have evolved over the years. However, some
manufacturers do not give the exact composition of their media but
merely state that for reasons of patent protection or as trade secret
they are constrained to give full details of the composition of their
media (J D Biggers, Reproductive Biomedicine Online, Vol.1, No.3,
2000; also available on the world-wide web; rbmonline.com). This is an
undesirable situation. Infertility clinics that deal with human embryos
and the future life of the products they create in the laboratory must be
privy to the knowledge about the media they use, if need be by signing
an appropriate confidentiality agreement which would prohibit the clinic
from using or passing on the proprietary information provided by the
manufacturers of the media to any other organization that may
commercially exploit this information. When a serum supplementation
has to be used in the preparation of media, one must carefully avoid
the risk of viral transmission to the embryo through the serum.

PART 5

5. Patient Selection

Patient selection for referral and, finally, for ART should be based on the
findings of basic investigations on the cause of infertility. These investigations
should include the following:

5.1 Husband

Physical examination, both systemic and local, to detect any

problem that might be the cause of infertility or that may modify
the management of infertility.

Detailed semen analysis; if any abnormality is detected, repeat

tests should be done after suitable intervals. An abnormal
finding on a repeat semen examination warrants full-scale
investigation by an appropriate specialist to ascertain the cause
and then institute the necessary treatment.

Screening for infections including syphilis, HBV, HCV and HIV

and their appropriate management.

If needed, appropriate endocrinological investigations and

therapy.

62
5.2 Wife

Physical examination, both systemic and local, to detect any

problem that might be the cause of infertility or that may modify
the management of infertility.

Detection and timing of ovulation by appropriate tests, for

example, cervical mucus studies, ultrasonography, premenstrual
endometrial biopsy, histopathological examination, and serum
progesterone estimation in the midluteal phase.

Assessment of tubal patency by appropriate investigations such

as hystero-salpingography, sonosalpingography, or laparoscopy
if required, to find out / rule out specific problems and to select
the appropriate therapy.

Screening for local factors including cervical mucus-related

problems and lower genital tract infections, and instituting
appropriate therapy.

Assessment of uterine cavity by hysteroscopy if needed.

Screening for HBV, HCV and HIV, and for other reproductive
tract infections such as syphilis, Chlamydia, and tuberculosis if
necessary.

If needed, appropriate endocrinological investigations and

therapy.

Any gynaecologist not specifically trained in the subspeciality of

infertility care can also complete these investigations. Based on the
results of these investigations, couples should be selected for
treatment at different levels of infertility care units (described in Part-1).

5.3 Patient selection for treatment in different infertility care units

In general, infertile couples can be categorized broadly into three

groups; (1) those with single defect in one of the partners; (2) those
with multiple defects in one or both the partners; (3) no apparent defect
in either partner (unexplained infertility).

5.4 Single defect in one of the partner

The fault may exist either in the male or in the female partner. The
defect may be either treatable or untreatable. For example, in the
female partner, a treatable defect could be tough or imperforate
hymen, or oligo or anovulation due to polycystic ovary syndrome or a
sub-mucous fibroid. The untreatable female partner defects would

63
 include premature ovarian failure, absence of uterus, dense pelvic
adhesions due to endometriosis, tuberculosis, and pelvic inflammatory
disease as a sequel to pelvic surgery. Unlike female factor infertility,
male factor infertility is seldom easily correctable. If a single defect in
one of the partners is correctable, some of the patients will respond to
conventional medical or surgical therapy while the others will not.
Further treatment for the unresponsive couples will then consist of
counselling and an in-depth investigation, leading to the use of ART
failing which, adoption may be the only alternative. For an
uncorrectable single defect, either in the male or in the female partner,
the choice would be between ART and adoption. The alternative to be
chosen should be suggested by the counsellor after evaluation of the
age, financial capabilities and psychological attitude of the couple.

5.5 Multiple defects in one or both partners

When multiple defects involve either one or both partners, attempt to

correct these defects and hoping to achieve a pregnancy in the natural
way is many-a-time unsuccessful. This should be explained by the
consulting gynaecologist / physician to the couple to prevent
unnecessary expenditure by the couple. Judicious and effective
counselling plays a very vital role under such circumstances; at least
some couples will accept that at this point their treatment (such as
surgical) ends. Some of them will then opt for adoption while others
might wish to try the challenges of ART procedures.

PART 6

6. Selection criteria for ART

The choice of the procedure used, e.g. IVF-ET, GIFT, ZIFT, or ICSI, is made
depending upon the needs, resources and circumstances of the couple,
availability of the facilities, and experience and expertise of the gynaecologist
/ embryologist.

6.1 Tubal disease

IVF-ET can be offered where microsurgical techniques for tubal and

peritoneal disease have failed or are unlikely to benefit the patient.
The presence of peritubal adhesions, condition of the tubal wall,
condition of the ciliary epithelium and degree of fimbrial damage would
dictate the choice between IVF and microsurgery. Patients who have
already undergone tuboplasty and those with inaccessible ovaries
would be more suitable for IVF. In case of history of ectopic
pregnancy, IVF would be a better option.

64
6.2 Endometriosis

IVF is a suitable option for (a) women with moderate to severe

endometriosis; (b) those in whom medical or surgical therapy has
failed; and (c) sometimes in cases of mild to moderate endometriosis in
the presence of other factors contributing to infertility.

6.3 Unexplained infertility

Couples who have prolonged unexplained infertility could benefit from

IVF, as many factors such as subtle ovulation defects, defects in ovum
pick-up, gamete transport, tubal environment, sperm abnormality, or
oocyte abnormality, may come to light when IVF is used.

6.4 Immunological factor

IVF can be used when there are antisperm antibodies either in the
male or the female and when other techniques such as
immunosuppression, use of condoms, intrauterine insemination and
other therapeutic measures have failed.

6.5 Cervical factor

IVF may be offered for cervical factor only if repeated attempts (6 to 8

cycles) of intrauterine insemination have failed and other therapies
have not resulted in pregnancy.

6.6 Male factor

IVF-ET is the logical therapy in cases of low concentrations of sperm

(say less than 10 million/ml), low motility (less than 30%), and / or
abnormal sperm morphology (presence of >60% abnormal forms). No
universally accepted minimal sperm concentration for success in IVF
exists. In cases of severe male factor infertility, assisted fertilization by
means of micromanipulation and sperm injection (ICSI) can be offered
even in obstructive and non-obstructive cases. In severe
oligozoospermia, teratozoospermia, cryptozoospermia and azospermia
(obstructive / non-obstructive), ICSI can be employed using either
ejaculated or epididiymal sperm.

6.7 Ovarian disorders

IVF-ET can benefit patients with hypogonadotropic anovulation,

oligoovulation and luteal phase deficiency, although IVF is rarely
indicated when these disorders exist as isolated conditions. IVF-ET
can be used for women with luteinized unruptured follicle syndrome in
polycystic ovarian disease.

65
6.8 Uterine disorders

Patients with Mullerian agenesis or congenital uterine anomalies,

women with severe intrauterine adhesion refractory to surgical lysis of
the adhesion, and hysterectomized patients can, through IVF, transfer
their embryos to a surrogate mother.

6.9 Use of donor oocytes and donor embryos

Women who have undergone premature or timely menopause and

women in the perimenopausal age group who do not show proper
recruitment of follicles and who have other existing causes of infertility,
can avail of the option of donor oocytes and donor embryos. Women
with genetic disorders, those who have undergone radiation therapy,
and those with ovaries that are not accessible by ultrasound due to
severe adhesions, can also be advised to avail of donor oocytes for
IVF-ET.

6.10 Selection criteria for gamete intra-fallopian transfer (GIFT)

The indications for GIFT are almost similar to that for IVF-ET, except
that GIFT cannot be performed on those who have both the fallopian
tubes blocked.

6.11 Choosing between IVF-ET and GIFT

Decision in regard to which of these techniques should be utilized,

must be individualized for each patient. The advantages of IVF over
GIFT are documentation of fertilization, less trauma and relatively lower
anaesthetic risk. There is no exposure to excess quantities of carbon
dioxide in IVF as happens during laparoscopic insufflation with GIFT.
On the other hand, GIFT is more natural as fertilization occurs in the
tubal ampulla, the gametes are minimally exposed in vitro, and early
embryo development occurs in a natural environment.

6.12 Micro-manipulation of gametes and embryos (SUZI and ICSI), AH

and embryo biopsy

Subzonal insemination (SUZI), intracytoplasmic sperm injection (ICSI)

and assisted hatching (AH) need micromanipulation of gametes. SUZI
involves sperm injection in vitro, into the subzonal space of oocytes.
This technique has now been virtually totally replaced by ICSI, which
involves injection of sperm into the cytoplasm of the oocyte and which
is useful in a variety of cases such as aging ova, elderly women,
repeated failure of implantation in IVF, and in certain cases of male
factor infertility. Assisted hatching of embryo by drilling a hole in the
zona pellucida is resorted prior to embryo transfer for improving
implantation rates. Embryo biopsy is a procedure in which one or more
blastomeres are removed from the embryo for PGS (Preimplantation
Genetic Screening) to improve implantation rates, or for PGD

66
 (Preimplantation Genetic Diagnosis) to rule out genetic disorders; it
must not be used for sex determination / selection unless medically
indicated.

6.13 Complications

ART procedures carry a small risk both to the mother and the offspring.
These risks must be explained to the couple and appropriate
counselling done. ART procedures are to be initiated only after
patients understand these risks and still want to undergo ART. Some
of the most commonly encountered risks are mentioned in the following
four sub-sections (this list is not exhaustive).

6.13.1 Multiple gestation

Specific efforts must be made to reduce the incidence of

multiple pregnancies. Therefore, not more than three oocytes
should be transferred for GIFT and not more than three embryos
for IVF-ET at one sitting, excepting under exceptional
circumstances (such as elderly women, poor implantation,
advanced endometriosis or poor embryo quality) which should
be recorded; the remaining embryos, if any, may be
cryopreserved and, if required, transferred at a later cycle.

6.13.2 Ectopic pregnancy

Ectopic pregnancy rates could be as high as 5% for ART

procedures. The choice of an appropriate procedure as per
guidelines given earlier, especially in persons with tubal disease,
may reduce the chances of an ectopic pregnancy.

6.13.3 Spontaneous abortion

Abortion rates rise with increasing age of the mother and in

multiple pregnancies, especially with three or more fetuses. In
cases where more than two fetuses are present, selective
embryo reduction may be advised. It is essential that the
advantages of foetal reduction (better chances of the survival of
the other fetuses and the fact that they are likely to be born
nearer term and with better birth weight) and disadvantages (the
possibility that there might be an increased risk of abortion
following the procedure) must be explained to the couple, and
their informed consent taken before embryo reduction is
attempted.

6.13.4 Ovarian hyperstimulation syndrome

The use of superovulation for ART entails a risk of

hyperstimulation in some women, in the range of 0.2 to 8.0%.
The extent of this risk is determined by the number of follicles

67
 and eggs, the estradiol values (greater than 2500 pg/ml), the
dose used for triggering ovulation, the ability to aspirate all the
follicles at the time of oocyte retrieval, and several other factors.
The programme director should be fully aware of the means to
avoid hyperstimulation and also its treatment. Careful
monitoring and management will reduce this risk as well as the
morbidity associated with it.

PART 7

7 Information and counselling to be given to patients

Information must be given to couples seeking treatment, on the points given in

the following paragraphs:

The basis, limitations and possible outcome of the treatment proposed,

variations in its effectiveness over time, including the success rates
with the recommended treatments obtained in the clinic as well as
around the world (this data should be available as a document with
references, and updated every 6-12 months).

The possible side-effects (e.g. of the drug used) and the risks of
treatment to the women and the resulting child, including (where
relevant) the risks associated with multiple pregnancy.

The need to reduce the number of viable foetuses, in order to ensure

the survival of at most two foetuses.

Possible disruption of the patients domestic life which the treatment

may entail.

The techniques involved, including (where relevant) the possible

deterioration of gametes or embryos associated with storage, and
possible pain and discomfort.

The cost (with suitable break-up) to the patient of the treatment

proposed and of an alternative treatment, if any (there must be no
other hidden costs).

The importance of informing the clinic of the result of the pregnancy in

a pre-paid envelope.

The need to make the couple aware, if relevant, that a child born
through ART has a right to seek information about his genetic parent /
surrogate mother on reaching 18 years, excepting information on the
name and address that is, the individuals personal identity of the
gamete donor or the surrogate mother. The couple is not obliged to

68
 provide the information to which the child has a right, on their own to
the child when he / she reaches the age of 18, but no attempt must be
made by the couple to hide this information from the child should an
occasion arise when this issue becomes important for the child.

The advantages and disadvantage of continuing treatment after a

certain number of attempts.

Pamphlets (one-page on each technique in all local languages and English)

which give clear, precise and honest information about the procedure
recommended to be used will help the couple make an informed choice.

69
 FORM - A
(See Rules 10.1 and 14.1)

FORM OF APPLICATION FOR REGISTRATION OR RENEWAL OF

REGISTRATION OF AN INFERTILITY / ART CLINIC
(To be submitted in duplicate with supporting documents as enclosures, also in
duplicate)
[Attach separate sheets where necessary]

1. Full name and address / addresses of ART Clinic with telephone/telegraphic

address / telex / fax / e-mail

2. Name of the person to whom correspondence should be addressed (specify

Shri / Smt. / Kum. / Dr.)

3. Address of the above person

4. Designation of the above person [specify owner / partner / managing director /

other (to be stated)]

5. Type of facility to be registered

(specify Primary (Level 1B) / Secondary (Level 2) / Tertiary (Level 3) ART
Clinic)

6. Type of ownership and organization (specify individual ownership/partnership

/ company / co-operative / any other). In case of type of organization other
than individual ownership, furnish copy of articles of association and names
and addresses of other persons responsible for management, as enclosures

7. Type of institution (Govt. Hospital / Municipal Hospital / Public Hospital /

Private Hospital / Private Nursing Home / Private Clinic / Private Laboratory /
any other to be stated)

8. ART procedures for which facilities exist

9. Space available for the ART Clinic (give total work area excluding lobbies,
waiting rooms, stairs etc; enclose floor plan)

10. Instruments and equipment available, with the make and model of each
equipment (list on a separate sheet)

11. Laboratory tests for which facilities are available at the ART Clinic:

(a)
(b)
(c) .
.

70
12. Staff members, with qualifications, experience and duties of each
(list on a separate sheet)

13. For renewal application only:

(a) Registration No.

(b) Date of issue and date of expiry of the existing
Certificate of Registration

14. List of enclosures:

Please attach a list of enclosures giving the supporting documents submitted

with this application.

(.)
Name and signature of applicant

Date :
Place :

DECLARATION

I, Shri / Smt./ Kum. / Dr. ., son / daughter /

wife of , aged . years, resident of ..
....,
hereby declare that I have read and understood the Assisted Reproductive
Technology (Regulation) Act, 2008, and the Assisted Reproductive Technology
(Regulation) Rules, 2008.

2. I also undertake to explain the said Act and Rules to all employees of the ART
Clinic in respect of which registration is sought, and ensure that the Act and the
Rules are fully complied with.

(..)
Name and signature of applicant

Date:
Place:

[Strike out whichever is not applicable or not necessary. All enclosures are to be
authenticated by signature of the applicant.]

71
 ACKNOWLEDGEMENT
(See Rule 10.2]

The application in Form A in duplicate for grant* / renewal* of registration ART Clinic
by . (name and address of applicant) has
been received by the Appropriate Authority . on
. (date).

The list of enclosures attached to the application in Form A has been verified with
the enclosures submitted and found to be correct.

*OR

On verification it is found that the following documents mentioned in the list of

enclosures are not actually enclosed.

This acknowledgement does not confer any rights on the applicant for grant or
renewal of registration.

(.)
Signature and designation of
Registration Authority, or
authorized person in the
Office of the Registration Authority.

Date: SEAL

ORIGINAL
DUPLICATE FOR DISPLAY

*Strike out whichever is not applicable or necessary.

72
 FORM A (1)
(See Rules 10.1 and 14.1)

FORM OF APPLICATION FOR REGISTRATION OR RENEWAL OF

REGISTRATION OF A SEMEN BANK
(To be submitted in duplicate with supporting documents as enclosures, also in
duplicate)
[Attach separate sheets where necessary]

1. Full name and address / addresses of the Semen Bank with telephone /
telegraphic address / telex / fax / e-mail

2. Name of the person to whom correspondence should be addressed (specify

Shri / Smt. / Kum. / Dr.)

3. Address of the above person

4. Designation of the above person [specify owner / partner / managing director /

other (to be stated)]

5. Type of ownership and organization (specify individual ownership /partnership

/company / co-operative / any other). In case of type of organization other
than individual ownership, furnish copy of articles of association and names
and addresses of other persons responsible for management, as enclosures

6. Type of institution (Govt. / Private / any other to be stated)

7. Space available (give total work area excluding stairs etc; attach floor plan)

8. Instruments and equipment available, with the make and model of each
equipment (list on a separate sheet)

9. Laboratory tests for which facilities are available at the Semen Bank:

(a)
(b)
(c) .
.

10. Staff members, with qualifications, experience and duties of each (list on a
separate sheet)

11. For renewal application only:

(a) Registration No.

(b) Date of issue and date of expiry of the existing
Certificate of Registration

73
12. List of enclosures:

Please attach a list of enclosures giving the supporting documents submitted

with this application.

(.)
Name and signature of applicant

Date :
Place :

DECLARATION

I, Shri / Smt./ Kum. / Dr. . , son / daughter /

wife of , aged . years, resident of ....
..
....,
hereby declare that I have read and understood the Assisted Reproductive
Technology (Regulation) Act, 2008, and the Assisted Reproductive Technology
(Regulation) Rules, 2008, and that the Semen Bank on behalf of which I am making
this application operates independently of and is not a part of any ART clinic.

2. I also undertake to explain the said Act and Rules to all employees of the ART
Clinic in respect of which registration is sought, and ensure that the Act and the
Rules are fully complied with.

(..)
Name and signature of applicant

Date:
Place:

[Strike out whichever is not applicable or not necessary. All enclosures are to be
authenticated by signature of the applicant.]

74
 ACKNOWLEDGEMENT
(See Rule 10.2]

The application in Form A in duplicate for grant* / renewal* of registration of

. (Semen Bank) by .
(name and address of applicant) has been received by the Appropriate Authority
. on . (date).

The list of enclosures attached to the application in Form A has been verified with
the enclosures submitted and found to be correct.

*OR

On verification it is found that the following documents mentioned in the list of

enclosures are not actually enclosed.

This acknowledgement does not confer any rights on the applicant for grant or
renewal of registration.

(.)
Signature and designation of
Registration Authority, or
authorized person in the
Office of the Registration Authority.

Date: SEAL

ORIGINAL
DUPLICATE FOR DISPLAY

*Strike out whichever is not applicable or necessary.

75
 FORM A (2)
(See Rules 10.1 and 14.1)

FORM OF APPLICATION FOR REGISTRATION OR RENEWAL OF

REGISTRATION OF A RESEARCH CENTRE USING HUMAN EMBRYOS
(To be submitted in duplicate with supporting documents as enclosures, also in
duplicate)
[Attach separate sheets where necessary]

1. Full name and address / addresses of the Research Centre with telephone /
telegraphic address / telex / fax / e-mail

2. Name of the person to whom correspondence should be addressed (specify

Shri / Smt. / Kum. / Dr.)

3. Address of the above person

4. Designation of the above person

5. Type of institution (Govt. / Private)

6. If Private, is the institution recognized as a research centre by the Dept. of

Scientific and Industrial Research, Government of India ?

7. Total floor area of the Research Centre

8. Major Instruments and equipments available, with the make and model of
each equipment (list on a separate sheet)

9. Members of the top administrative body / research advisory committee

10. Top 20 members of the scientific staff with qualifications and experience

11. Does the Research Centre publish an annual report ? If so, please attach a
copy of the last report.

12. For renewal application only:

(a) Registration No.

(b) Date of issue and date of expiry of the existing
Certificate of Registration

13. List of enclosures:

Please attach a list of enclosures giving the supporting documents

submitted with this application.

Date: (.)
Place: Name and signature of applicant

76
DECLARATION

I, Shri / Smt./ Kum. / Dr. . , son / daughter /

wife of , aged . years, resident of ...
..
....,
hereby declare that I have read and understood the Assisted Reproductive
Technology (Regulation) Act, 2008, and the Assisted Reproductive Technology
(Regulation) Rules, 2008, and that the Semen Bank on behalf of which I am making
this application operates independently of and is not a part of any ART clinic.

2. I also undertake to explain the said Act and Rules to all employees of the
Research Centre in respect of which registration is sought, and ensure that the Act
and the Rules are fully complied with.

(..)
Name and signature of applicant

Date:
Place:

[Strike out whichever is not applicable or not necessary. All enclosures are to be
authenticated by signature of the applicant.]

77
 ACKNOWLEDGEMENT
(See Rule 10.2]

The application in Form A in duplicate for grant* / renewal* of registration of

. (Research Centre) by .
(name and address of applicant) has been received by the Appropriate Authority
. on . (date).

The list of enclosures attached to the application in Form A has been verified with
the enclosures submitted and found to be correct.

*OR

On verification it is found that the following documents mentioned in the list of

enclosures are not actually enclosed.

This acknowledgement does not confer any rights on the applicant for grant or
renewal of registration.

(.)
Signature and designation of
Registration Authority, or
authorized person in the
Office of the Registration Authority.

Date: SEAL

ORIGINAL
DUPLICATE FOR DISPLAY

*Strike out whichever is not applicable or necessary.

78
 FORM - B
(See Rule 12.1)

CERTIFICATE OF REGISTRATION
(To be issued in duplicate)

1. In exercise of the powers conferred under Section 11(6) of the Assisted

Reproductive Technology (Regulation) Act, 2008, the Appropriate Authority
. hereby grants registration to
the ART Clinic of Level 1B / Level 2 / Level 3* named below for purposes of
carrying out Assisted Reproductive Technology Procedures as per the
aforesaid Act, for a period of three years ending on

A. Name and address of the ART Clinic

B. Name of applicant for registration

2. This registration is granted subject to the aforesaid Act and Rules thereunder
and any contravention thereof shall result in suspension or cancellation of this
certificate of registration before the expiry of the said period of three years.

3. Registration No. allotted

4. For renewed Certificate of Registration only:

Period of validity of earlier Certificate of Registration from . to

Signature, name and designation of

the Registration Authority

Date:

SEAL

DISPLAY ONE COPY OF THIS CERTIFICATE AT A CONSPICUOUS PLACE AT

THE PLACE OF BUSINESS

*Strike out whichever is not applicable or necessary.

79
 FORM - C
(See Rule 12.2)

REJECTION OF APPLICATION FOR REGISTRATION OR

RENEWAL OF REGISTRATION

In exercise of powers conferred under Section 11(6) of the Assisted Reproductive

Technology (Regulation) Act 2008, the Appropriate Authority hereby rejects the
application for grant* / renewal* of registration of the ART Clinic named below for the
reasons stated.

Name and address of the ART Clinic :

Name of applicant who has applied for registration :

Reasons for rejection of application for registration :

Signature, name and designation

of the Registration Authority

Date:

SEAL

*strike out whichever is not applicable or necessary

80
 FORM - D
Consent Form to be signed by the Couple for IVF and ICSI
(See Rule 15.1)

We have requested the Centre (named above) to provide us with treatment services
to help us bear a child.
We understand and accept (as applicable) that:
1. The drugs that are used to stimulate the ovaries to raise oocytes have
temporary side effects like nausea, headaches and abdominal bloating. Only
in a small proportion of cases, a condition called ovarian hyperstimulation
occurs where there is an exaggerated ovarian response. Such cases can be
identified ahead of time but only to a limited extent. Further, at times the
ovarian response is poor or absent in spite of using a high dose of drugs.
Under these circumstances, the treatment cycle will be cancelled.
2. There is no guarantee that:

a. The oocytes will be retrieved in all cases.

b. The oocytes will be fertilized.
c. Even if there were fertilization, the resulting embryos would be of
suitable quality to be transferred.

All these unforeseen situations will result in the cancellation of any treatment.
3. There is no certainty that a pregnancy will result from these procedures even
in cases where good quality embryos are transferred.
4. Medical and scientific staff can give no assurance that any pregnancy will
result in the delivery of a normal living child.
5. Endorsement by the ART Clinic

I/we have personally explained to ___________________________________

and _____________________ the details and implications of his / her / their
signing this consent / approval form, and made sure to the extent humanly
possible that he / she / they understand these details and implications.

6. This consent would hold good for all the cycles performed at the clinic.

Name and signature of the Male Partner

Name and signature of the Female Partner

Name, address and signature
of the Witness from the clinic
Name and signature of the Doctor

Name and address of the ART clinic

Dated:

81
 FORM - E

Consent for Artificial Insemination or Intrauterine Insemination with Husbands

Semen / Sperm
(See Rule 15.1)

_________________________________________ and ______________________

_________________________, being husband and wife and both of legal age,
authorize Dr.________________________ to inseminate the wife artificially or
intrauterine with the semen / sperm of the husband for achieving conception.

We understand that even though the insemination may be repeated as often

as recommended by the doctor, there is no guarantee or assurance that pregnancy
or a live birth will result.

We have also been told that the outcome of pregnancy may not be the same
as those of the general pregnant population, for example in respect of abortion,
multiple pregnancies, anomalies or complications of pregnancy or delivery.

The procedure carried out does not ensure a positive result, nor does it
guarantee a mentally and physically normal child. This consent holds good for all
the cycles performed at the clinic.

Endorsement by the ART Clinic

I / we have personally explained to _________________ and _________________

the details and implications of his / her / their signing this consent / approval form,
and made sure to the extent humanly possible that he / she / they understand these
details and implications.

Name, address and signature of the Witness from the clinic

Signed: _________________ (Husband)

_____________________(Wife)

Name and signature of the Doctor

Name and address of the ART clinic

Dated:

82
 FORM - F

Consent for Artificial Insemination or Intrauterine Insemination with Donor

Semen
(See Rule 15.1)

We, _______________________________________________________ and

____________________________, being husband and wife and both of legal age,
authorize Dr.___________________________ to inseminate the wife artificially or
intrauterine with semen / sperm of a donor (semen banks
no._______________________; obtained from _______________________ semen
bank with valid registration no.) for achieving conception.

We understand that even though the insemination may be repeated as often

as recommended by the doctor, there is no guarantee or assurance that pregnancy
or a live birth will result.

We have also been told that the outcome of pregnancy may not be the same
as those of the general pregnant population, for example in respect of abortion,
multiple pregnancies, anomalies or complications of pregnancy or delivery.

We declare that we shall not attempt to find out the identity of the donor.

I, the husband, also declare that should my wife bear any child or
children as a result of such insemination(s), such child or children shall be as
my own and shall be my legal heir(s).

The procedure carried out does not ensure a positive result, nor does it
guarantee a mentally and physically normal body. This consent holds good for all
the cycles performed at the clinic.

83
Endorsement by the ART Clinic

I / we have personally explained to ___________________ and

______________ the details and implications of his / her / their signing this consent /
approval form, and made sure to the extent humanly possible that he / she / they
understand these details and implications.

Name, address and signature

of the Witness from the clinic

Signed :__________________________(Husband)

_________________________(Wife)

Name and signature of the Doctor

Name and address of the ART clinic

Dated:

84
 FORM - G
Consent for Freezing of Embryos
(See Rule 15.1)

We, _______________________________________________________ and

___________________________________________, consent to freezing of the
embryos that have resulted out of IVF/ICSI with our gametes. We understand that
the embryos would be normally kept frozen for five years. If we wish to extend this
period, we would let you (the ART Clinic) know at least six months ahead of time. If
you do not hear from us before that time, you will be free to (a) use the embryos for a
third party; (b) use them for research purposes; or (c) dispose them off. We also
understand that some of the embryos may not survive the subsequent thaw and that
frozen embryo-replaced cycles have a lower pregnancy rate than when fresh
embryos are transferred.

*Husband / man

In the unforeseen event of my death, I would like

The embryos to perish

To be donated to my wife / partner

To be donated to a third party

Used for research purposes

Signed: Dated:

85
*Wife / woman

In the unforeseen event of my death, I would like

The embryos to perish

To be donated to my husband / partner

To be donated to a third party

Used for research purposes

Signed: Dated:

Endorsement by the ART Clinic

I / we have personally explained to ___________________________ and

_________________ the details and implications of his / her / their signing this
consent / approval form, and made sure to the extent humanly possible that he / she
/ they understand these details and implications.

Name, address and signature of the Witness from the clinic

Name and signature of the Doctor Dated

Name and address of the ART clinic

*The appropriate option may be ticked

86
 FORM - H

Consent for the Procedure of PESA and TESA

(See Rule 15.1)

Name of female partner

Name of male partner

We hereby request and give consent to the procedure of PESA and TESA for
ICSI, to be performed on the male partner.

We understand that
a) There is no guarantee that the sperm will be successfully removed or
that sperm will necessarily fertilise our oocytes.

b) Should the sperm retrieval fail, the following options will be available for
the retrieved oocytes.

i) Insemination of all or some oocytes using donor sperm

ii) Donation of oocytes to another infertile couple

iii) Disposal of oocytes according to the ethical guidelines

(Tick the appropriate option)

Each of the above points has been explained to us by

_____________________

The procedure(s) carried out does (do) not ensure a positive result, nor do
they guarantee a mentally and physically normal body. This consent holds good for
all the cycles performed at the clinic.

87
Endorsement by ART Clinic

I/we have personally explained to _______________________ and

____________ the details and implications of his / her / their signing this consent /
approval form, and made sure to the extent humanly possible that he / she / they
understand these details and implications.

Signature of Male Partner

Name, address and
signature of the Witness
from the clinic
Signature of Female Partner

Name and signature of the Doctor

Name and address of the ART clinic

Dated

88
 FORM - I
Consent for Oocyte Retrieval / Embryo Transfer
(See Rule 15.1)

Womans name:

Womans address:

Name and address of the Clinic:

I have asked the Clinic named above to provide me with treatment services to
help me bear a child. I consent to:

a) Being prepared for oocyte retrieval by the administration of hormones

and other drugs

b) The removal of oocytes from my ovaries under ultrasound guidance /

laparoscopy

c) The mixing of the following (using technologies such as IVF or ICSI):

My oocytes the sperm of my husband

Anonymous donor oocyte anonymous donor sperm

d) the placing in my ___________________________ of

e) 1. ____________ (no) of the oocytes mixed with the sperm

f) 2. ____________ (no) of the resulting embryos

g) 3. ____________ (no) of our cryo-preserved embryos

h) 4. ____________ (no) of embryo(s) obtained anonymously

(Tick the appropriate and strike off the others)

I had a full discussion with _______________________________ about the

above procedures and I have been given oral and written information about them.

I consent that I shall be the legal mother of the child and the child will have all
the legal rights on me, in case of anonymous gamete / embryo donation.

89
 I have been given a suitable opportunity to take part in counselling about the
implications of the proposed treatment.

The type of anaesthetic proposed (general / regional / sedation) has been

discussed in terms which I have understood.

Endorsement by the ART Clinic

I/we have personally explained to _____________________ and

_______________ the details and implications of her signing this consent / approval
form, and made sure to the extent humanly possible that she understands these
details and implications.

Signature of Female Partner

Name, address and signature

of the Witness from the clinic

Name and signature of the Doctor

Consent of Husband

As the husband, I consent to the course of the treatment outlined above. I

understand that I will become the legal father of any resulting child, and that the child
will have all the normal legal rights on me.

Name, address and signature: __________________________________________

(Husband)

Name, address and signature

of the Witness from the clinic: ___________________________________________

Name and signature of the Doctor: _______________________________________

Dated

90
 FORM - J
Agreement for Surrogacy
(See Rule 15.1)

I, __________________________________ (the woman), with the consent of

my husband (name), of _________________________________________
(address) have agreed to act as a host mother for ___________________________
___________________________________________________________________
who are / is unable (or do not wish to) have a child by any other means.

I had a full discussion with ____________________________________ of

the clinic on _______________________ in regard to the matter of my acting as a
surrogate mother for the child of the above couple.

I understand that the methods of treatment may include:

1. Stimulation of the genetic mother for follicular recruitment

2. The recovery of one or more oocytes from the genetic mother by ultrasound
guided oocyte recovery or by laparoscopy.

3. The fertilization of the oocytes from the genetic mother with the sperm of her
husband or an anonymous donor.

4. The fertilization of a donor oocyte by the sperm of the husband.

5. The maintenance and storage by cryopreservation of the embryo resulting

from such fertilization until, in the view of the medical and scientific staff, it is
ready for transfer.

6. Implantation of the embryo obtained through any of the above possibilities into
my uterus, after the necessary treatment if any.

I have been assured that the genetic mother and the genetic father have been
screened for HIV and hepatitis B and C before oocyte recovery and found to be
seronegative for all these diseases. I have, however, been also informed that there

91
is a small risk of the mother or / and the father becoming seropositive for HIV during
the window period.

I consent to the above procedures and the administration of such drugs that
may be necessary to assist in preparing my uterus for embryos transfer, and for
support in the luteal phase.

I understand and accept that there is no certainty that a pregnancy will result
from these procedures.

I understand and accept that the medical and scientific staff can give no
assurance that any pregnancy will result in the delivery of a normal and living child.

I am unrelated / related (relation) ___________________________________

to the couple (the would-be genetic parents).

I have worked out the financial terms and conditions of the surrogacy with the
couple in writing and an appropriately authenticated copy of the agreement has been
filed with the clinic, which the clinic will keep confidential.

I agree to hand over the child to ____________________, or _____________

and _____________________ in case of a couple, or to ______________________
in case of their separation during my pregnancy, or to the survivor in case of the
death of one of them during pregnancy, as soon as I am permitted to do so by the
hospital / clinic / nursing home where the child is delivered.

I undertake to inform the ART Clinic, _________________________, of the

result of the pregnancy.

I take no responsibility that the child delivered by me will be normal in all

respects. I understand that the biological parent(s) of the child has / have a legal
obligation to accept the child that I deliver and that the child would have all the
inheritance rights of a child of the biological parent(s) as per the prevailing law.

92
 I will not be asked to go through sex determination tests for the child during
the pregnancy and that I have the full right to refuse such tests. I will, however,
agree to foetal reduction if asked by the party seeking surrogacy, in case I happen to
be carrying more than one foetus.

I understand that I would have the right to terminate the pregnancy at my will;
I will then refund all certified and documented expenses incurred on the pregnancy
by the biological parents or their representative. If, however, the pregnancy has to
be terminated on expert medical advice, these expenses will not be refunded.

I have been tested for HIV, hepatitis B and C and shown to be seronegative
for these viruses just before embryo transfer.

I certify that (a) I have not had any drug intravenously administered into me
through a shared syringe; (b) I have not undergone blood transfusion; and (c) I and
my husband have had no extramarital relationship in the last six months.

I also declare that I will not use drugs intravenously, undergo blood
transfusion excepting of blood obtained through a certified blood bank, and avoid
sexual intercourse during the pregnancy.

I undertake not to disclose the identify of the party seeking the surrogacy.

In the case of the death or unavailability of any of the party seeking my help
as the surrogate mother, I will deliver the child to ____________________________
or _________________________________ in this order; I will be provided, before
the embryo transfer into me, a written agreement of the above persons that they will
be legally bound to accept the child in the case of the above-mentioned eventuality.
(If applicable) My husband has approved my acting as a surrogate.
(Strike off if not applicable.)

93
Endorsement by the ART Clinic
I/we have personally explained to _____________________ and
______________ the details and implications of his / her / their signing this consent /
approval form, and made sure to the extent humanly possible that he / she / they
understand these details and implications.

Signed:
(Surrogate Mother)

Name, address and signature

of the Witness from the clinic

Name and signature of the Doctor

Name and address of the ART clinic

Dated

94
 FORM - K
Consent Form for the Donor of Eggs
(See Rule 15.1)

I, Ms.__________________________________ consent to donate my eggs

to couples who are unable to have a child by other means.

I have had a full discussion with Dr.__________________________________

(name and address of the clinician) on ____________________________________

I have been counselled by ________________________________________

(name and address of independent counsellor) on ___________________________

I understand that there will be no direct or indirect contact between me and

the recipient, and my personal identity will not be disclosed to the recipient or to the
child born through the use of my gamete.

I understand that I shall have no rights whatsoever on the resulting offspring

and vice versa.

I understand that the method of treatment may include:

Stimulating my ovaries for multifollicular development.
The recovery of one or more of my eggs under ultrasound-guidance or
by laparoscopy under sedation or general anesthesia.
The fertilization of my oocytes with recipients husbands or donor
sperm and transferring the resulting embryo into the recipient.

(If applicable) My husband has agreed to the donation of my oocyte. (Strike off if not
applicable.)

95
Endorsement by the ART Clinic

I / we have personally explained to _____________________________the

details and implications of her signing this consent / approval form, and made sure to
the extent humanly possible that she understands these details and implications.

Signed: _____________________________

Name, address and signature of the Witness from the clinic

Name and signature of the Doctor

Name and address of the ART clinic

Dated

96
 FORM - L
Consent Form for the Donor of Sperm
(See Rule 15.1)

I, Mr. ____________________________ consent to donate my sperm to

couples who are unable to have a child by other means.

I have had a full discussion with Dr. _________________________________

(name and address of the clinician) on ___________________________________,

I have been counselled by _______________________________________

(name and address of independent counsellor) on ___________________________

I understand that there will be no direct or indirect contact between the

recipient, and me, and my personal identity will not be disclosed to the recipient or to
the child born through the use of my gamete.

I understand that I shall have no rights whatsoever on the resulting offspring and
vice versa.
(If applicable) My wife has agreed to the donation of my sperm. (Strike off if
not applicable.)

Endorsement by the semen bank

I / we have personally explained to _________________________the details

and implications of his signing this consent / approval form, and made sure to the
extent humanly possible that he understands these details and implications.

Signed: ___________________
Name and signature of the Doctor

Name, address and signature

of the Witness from the Semen Bank
Name and address of the Semen Bank

Dated

97
 FORM - M
Information on Semen Donor
( See Rule 15.1 )

Date of filling the form:

BASIC INFORMATION:
1. Identification number (Donor ID)
2. Age / Date of birth
3. Marital status
4. Education :
a. Donor
b. Spouse
5. Occupation :
a. Donor
b. Spouse
6. Monthly income
7. Religion

HISTORY:
8. Obstetric history of wife :
a. Number of deliveries
b. Number of abortions
c. Other points of note
9. History of use of contraceptives

10. Medical history

11. Family history from the medical point of view

12. History of any abnormality in a child of the donor

98
13. History of blood transfusion

14. History of substance abuse

INVESTIGATIONS:
15. Blood group and Rh status
16. Complete blood picture:
a. Hb
b. Total RBC count
c. Total WBC count
d. Differential WBC count
e. Platelet count
f. Peripheral smear
17. Random blood sugar
18. Blood urea / Serum creatinine
19. SGPT
20. Routine urine examination
21. HBsAg status
22. Hepatitis C status
23. HIV (1) status with date of the tests done
24. Hemoglobin A2 (for thallasemia) status
25. HIV PCR (2) (positive or negative)
26. Any other specific test (3)

FEATURES:
27. Height
28. Weight
29. Colour of skin
30. Colour of hair
31. Colour of eyes

99
DETAILED PHYSICAL EXAMINATION:
32. Pulse
33. Blood pressure
34. Temperature
35. Respiratory system
36. Cardiovascular system
37. Per abdominal examination
38. Other systems

Footnotes:
(1) To be carried out every 6 months
(2) To be carried out if donor leaves within 6 months of the previous HIV test
(3) Any additional test carried out on the basis of the history and examination of
donor

All the tests should have been done within 15 days prior to the date of filling the
form.

Name and signature with date, of the person filling the form:

100
 FORM M (1)

Information on Egg Donor

( See Rule 15.1 )

Date of filling the form (except items 16-26)

Date of filling items 16-26

BASIC INFORMATION:
1. Identification number (Donor ID)
2. Age / Date of birth
3. Marital status
4. Education :
a. Donor
b. Spouse
5. Occupation :
a. Donor
b. Spouse
6. Monthly income
7. Religion

HISTORY:
8. Obstetric history
a. Number of deliveries
b. Number of abortions
c. Other points of note
9. Menstrual history

10. History of use of contraceptives

11. Medical history

101
12. Family history from the medical point of view

13. History of any abnormality in a child of the donor

14. History of blood transfusion

15. History of substance abuse

INVESTIGATIONS(1):
16. Blood group and Rh status
17. Complete blood picture:
a. Hb
b. Total RBC count
c. Total WBC count
d. Differential WBC count
e. Platelet count
f. Peripheral smear
18. Random blood sugar
19. Blood urea / Serum creatinine
20. SGPT
21. Routine urine examination
22. HBsAg status
23. Hepatitis C status
24. HIV status with date of the tests done

102
25. Hemoglobin A2 (for thallasemia) status
26. Any other specific test (2)

FEATURES:
27. Height
28. Weight
29. Colour of skin
30. Colour of hair
31. Colour of eyes

DETAILED PHYSICAL EXAMINATION:

32. Pulse
33. Blood pressure
34. Temperature
35. Respiratory system
36. Cardiovascular system
37. Per abdominal examination

Other systems

Footnotes:
(1) To be carried out within 15 days prior to oocyte donation
(2) Any additional test carried out on the basis of the history and examination of
donor

To the patient, a copy of this form without items 16-26 filled in, may be given when
asked for. The investigations in items 16-26 may be done when the patient has
chosen the donor provisionally, subject to the results of tests in items 16-26 being
satisfactory.

Name(s) and signature(s) with date, of persons filling the form:

103
 FORM M (2)

Information on Surrogate
( See Rule 15.1 )

Date of filling the form (except items 20-31)

Date of filling items 20-31

BASIC INFORMATION:
1. Identification number

2. Name

3. Age / Date of birth

4. Address

5. Photograph

6. Tel no.

7. Marital status

8. Education :
a. Surrogate
b. Spouse
9. Occupation :
a. Surrogate
b. Spouse
10. Monthly Income
11. Religion

HISTORY:
12. Obstetric history :
a. Number of deliveries
b. Number of abortions
c. Other points of note

104
13. Menstrual history

14. History of use of contraceptives

15. Medical history

16. Family history

17. Has she acted as surrogate earlier : Yes No

If so, how many times did it lead to a successful pregnancy?

18. History of blood transfusion

19. History of substance abuse

INVESTIGATIONS(1):
20. Blood group and Rh status

21. Complete blood picture

a. Hb

b. Total RBC count

c. Total WBC count

d. Differential WBC count

e. Platelet count

f. Peripheral smear

22. Random blood sugar

105
23. Blood urea / Serum creatinine

24. SGPT

25. Routine urine examination

26. HBsAg status

27. Hepatitis C status

28. HIV status

29. Hemoglobin A2 (for thallasemia) status

30. HIV PCR (1) :

a. Surrogate

b. Spouse

31. Any other specific test(2)

FEATURES:
32. Height

33. Weight

34. Colour of skin

35. Colour of hair

36. Colour of eyes

DETAILED PHYSICAL EXAMINATION:

37. Pulse

38. Blood pressure

39. Temperature

40. Respiratory system

41. Cardiovascular system

42. Per abdominal examination

43. Per speculum examination

106
44. Per vaginal examination

45. Trans-vaginal sonography

46. Other systems

Footnotes
(1) To be carried out within 15 days prior to embryo transfer. Test no.30 to be
done only if Test 28 is negative.
(2) Any additional test carried out on the basis of the history and examination of
the surrogate OR any test requested by the recipient who shall pay for the
additional requested test

To the patient, a copy of this form without items 20-31 filled in, may be provided
when asked for. The investigations in items 20-31 may be done when the patient
has chosen the surrogate provisionally, subject to the results of tests in items 20-
31 being satisfactory.

Name(s) and signature(s) with date(s) of person(s) filling the form:

107
 FORM - N
Results of screening of Semen Donors / Oocyte Donors / Surrogate Mothers
( See Rule 15.1 )
(To include every individual screened)
2nd date
Screened after six
Identification Suitable
Date(s) months Name+ Signature+
number for (Yes/No)
for semen
donors

A: Semen donation
B: Oocyte donation
C: Surrogate mother
+ Name and signature of the person certifying suitability or otherwise

108
 FORM - O
Record of use of Donor Gametes and Surrogates
(See Rule 15.1)
(A separate form to be used for each individual donor or surrogate)
Name of Semen Bank : Registration no.
A. For Donor Semen
Donor Name of person Receipt
Sample ID Collection date Signature Supply date ART Clinic Registration no.
ID signing attached

109
110
 FORM - O
B. For Oocyte Donors
Receipt attached
Donor ID Recruitment date Name of person signing Signature Supply date ART Clinic
(Yes / No)

111
 FORM - O
C. For Surrogate mother
Patient(s)
Surrogate ID Recruitment date Name of person signing Signature Supply date ART Clinic
Name(s) / ID

The Semen Bank will maintain a separate register which will give the name and address, telephone no. etc., of the donor /
surrogate that will match with the donor / surrogate ID mentioned above. This register will be kept in a safe, under lock and key,
and will be accessible to only a small number of persons in the Semen Bank who will be sworn on oath in Form V to maintain the
above identity secret.

112
 Form - P
Oocyte-Embryo Record
(See Rule 15.1)
Patient name: ID no.:

Day 0 Day 1 Day 2 Day 3 Day 4 Day 5

Date: Date: Sci: Date: Date: Date: Date: Frozen Info.
Time: Diss. Time: Sci.: Sci.: Sci.: Sci.: Date:
Sci.: Score Time: Time: Time: Time: Time: Time:
Dr.: Hrs.(from OPU): Hrs.: Hrs.: Hrs.: Hrs.: Method:
Hyal. Time: Sci: Slow / Vitri
Inject Time: Sci:
Grad
Egg Comm. PN PB Comm. Cell# Frag % Cell# Grade FATE Cell#/ Grade Straw no.
e
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Frozen embryo details :

Tank :
Canister :
Goblet/Loop :
Arrangement :

113
 Form - P (1)
Details of the Frozen Embryos

Patient name : ID No. :

Freeze date :

1st thaw : Date : Time :

Thaw medium :

Post-thaw
Cell stage /
Straw# cell stage / Fate
grade at freezing
grade
S
S
S
S
S

Embryos transferred : Sci.: Comments :

Date : Time : Dr. : Embryos remaining :

ASSISTED HATCHING : YES/NO

Date: Time: Sci:

2nd thaw : Date : Time :

Thaw medium:
Post-thaw
Cell stage /
Straw# cell stage / Fate
grade at freezing
grade
S
S
S
S
S

Embryos transferred : Sci.: Comments :

Date : Time : Dr. : Embryos remaining :

ASSISTED HATCHING : YES/NO

Date: Time: Sci.:

Date of freezing: Scheduled date of discard:

Frozen embryos: Discarded / Used for

Date: Sci.:

Explanation of non-standard abbreviations:

Sci. = Scientist; Diss.= Dissection; OPU = Ovum pick-up;
Hyal = Hyalase; Info. = Information; Vitri. = Vitrification;
PB = Polar bodies; PN = Pronuclei; Comm. = Comments; Frag = Fragmentation

114
 Form - Q
Semen Analysis Report
(See Rule 15.1)

Semen Bank Registration no.:

Donor ID no.:

Doctor Date & Time Abstinence (Days) Produced at

[ ] Centre [ ] Home

Purpose: [ ] IUI [ ] ANALYSIS [ ] FREEZING [ ] TRIAL WASH

Basic semen analysis

Pre wash Post wash Acceptable (WHO) values
Volume (ml) 2.0-5.0
Sperm count (mill/ml) 20
Motility (%) 50
Activity (%) (Rapid) (Moderate) (Slow) (Sluggish)
Viscosity [ ]0 [ ] 1+ [ ] 2+ [ ] 3+
Agglutination [ ]0 [ ] 1+ [ ] 2+ [ ] 3+

Debris [ ]0 [ ] 1+ [ ] 2+ [ ] 3+
Normal Morphology (%)
Morphological abnormalities: (%)
Head Mid-Piece Tail
Amorphous Cytoplasmic droplet Coiled tail
Elongated Others Short tail
Pyriform Hairpin tail
Macrocephalic Double tail
Microcephalic OTHERS
Broken neck
Double head
Others
Hypo-osmotic Swelling Test : %
Semen Frozen : [ ] Yes [ ] No No. of Vials Frozen : Location :

Remark : Acceptable / Not acceptable Biologist:

Name:

Signature:

If unacceptable, receipt of remaining semen sample returned to the donor along with
a copy of this report, should be attached.

115
 FORM - R

Contract between the Semen Bank and the Semen Donor

(See Rule 15.1)

The Semen Bank and the Donor agree to come into this contract today on the
______________ day of ____________________ month, 2008, in ____________
as per the following conditions.

First Part being __________ Semen bank, having its office at

____________________ , and the registered office at ________________________
, herein referred to as the Bank (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Bank);

And

Second Part being Mr. / Ms. ___________________________ aged ________

residing at _________________________________________________
_________________________________________________________________,
herein referred to as the Donor (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Clinic)

Whereas
1. The first part is a semen bank that is established, amongst other purposes, to
collect and store human semen for use in ART procedures.

2. The second part is an individual who has willingly agreed to donate his semen
to the Bank against a consideration for the same.

3. That the Bank and the Donor have therefore, come to form this contract to
facilitate the process with the laid down terms and conditions.

116
NOW THIS INDENTURE WITNESSETH THAT:

1. The Bank agrees to accept the semen of the Donor and to preserve it as per
the rules laid down in the ART (Regulation) Act.

2. The Donor agrees to disclose the true facts of himself and not to suppress
any personal details to the Bank, including family history, genetic background,
criminal background, religion, etc. The Bank agrees to keep all information
about the Donor confidential. No information shall be declared by the Bank
accept by an order of a court or to the Indian Council of Medical Research. If
any information is suppressed by the Donor and that suppression causes any
damage in the ART procedure or to the patient, then the Bank will not be
responsible for it but only the Donor will be responsible and punishable under
the provisions of law.

3. The Donor agrees to relinquish all parental rights over the child, which may be
conceived from his gamete.

4. The donor, if married, agrees to take consent of his wife before donating his
semen and also produce the same before the bank at the time of signing this
agreement.

5. The bank agrees to inform the Donor about all the tests that would be
necessary for the safety and protection of the ART procedure. The Donor
agrees to undergo all the tests required by the Bank. The Bank also agrees
to inform the Donor about the results of the above tests.

6. The Donor agrees to return to the Bank six months after the donation, to be
screened for HIV positivity, if the semen is initially found to be of acceptable
quality.

7. If the semen is not of acceptable quality, the Donor agrees that his semen that
was collected and analysed would be returned to him and no payment would
be due to him from the Bank.

117
8. The Bank agrees to pay the Donor a sum of Rs.________________ for each
donation of his semen, if the semen is found to be of acceptable quality. Fifty
per cent of the above sum shall be paid to the Donor by the Bank
immediately after the donation; the remaining fifty per cent shall be paid to
him on his testing negative for HIV after 6 months.

9. The Donor agrees to accept the above amount and thereafter make no other
demands for the donation of semen by him.

10. The Bank and the Donor agree to abide by all the relevant provisions of
Chapters V and VII, relating to sourcing, storage, handling and record
keeping for gametes, embryos and surrogate, and rights and duties of
patients, donors, surrogates and children, respectively, of the ART
(Regulation) Act.

11. This agreement is signed by both the parties after a clear understanding of all
the issues involved, and in full senses and under no pressure from any
person.

_________________________ ________________________
_________________________ ________________________
First Part Second Part

__________________________ ________________________
__________________________ ________________________

Witness 1 Witness 2

Name, address and telephone number of the witnesses:

118
 FORM R (1)

Contract between the Semen Bank and the Oocyte Donor

(See Rule 15.1)

The Semen Bank and the Donor agree to come into this contract today on the
______________ day of _________________ month, 2008, in _________________
as per the following conditions.

First Part being _______________ semen bank, having its office at

____________________, and the registered office at ________________________,
herein referred to as the Bank (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Bank);

And

Second Part being Ms. _________________________________ aged __________

residing at __________________________________________________________
___________________________________________________________________,
herein referred to as the Donor (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Clinic)

Whereas

1. The first part is semen bank that is established, amongst other purposes, to
collect, screen and supply oocyte donor to ART clinics for use in ART
procedures.

2. The second part is an individual who has willingly agreed to donate her
oocytes to the ART clinic against a consideration for the same.

3. That the Bank and the Donor have, therefore, come to form this contract to
facilitate the process with the laid down terms and conditions.

119
NOW THIS INDENTURE WITNESSETH THAT:

1. The Bank agrees to screen and select oocyte donors and to supply them to
ART clinics desiring of oocyte donors as per the rules laid down in the ART
(Regulation) Act.

2. The donor agrees to disclose the true facts of himself and not to suppress any
personal details to the Bank, including family history, genetic background,
criminal background, religion, etc. The Bank agrees to keep all information
about the Donor confidential. No information shall be declared by the Bank
accept by an order of a court or to the Indian Council of Medical Research. If
any information is suppressed by the Donor and that suppression causes any
damage in the ART procedure or to the patient, then the Bank will not be
responsible for it but only the Donor will be responsible and punishable under
the provisions of law.

3. The Donor agrees to relinquish all parental rights over the child, which may be
conceived from her gamete.

4. The donor, if married, agrees to take consent of her husband before donating
her oocytes and also produce the same before the bank at the time of signing
this agreement.

5. The bank agrees to inform the Donor about all the tests that would be
necessary for the safety and protection of the ART procedure. The Donor
agrees to undergo all the tests required by the Bank. The Bank also agrees
to inform the Donor about the results of the above tests.

6. The Donor agrees to be assigned to any ART clinic as directed by the Bank
for the purposes of undergoing oocyte donation.

7. The Donor agrees to undergo ovarian stimulation by taking regular medication

as directed by the ART clinic and come regularly for follow up as directed.

8. The Donor agrees not to discontinue treatment midway except on medical

advice of the ART clinic.

120
9. The Bank agrees to pay the Donor a sum of Rs.____________________ for
each oocyte donation procedure. Ten per cent of the above sum shall be paid
to the Donor by the Bank on initiation of stimulation by the ART clinic; the
remaining ninety per cent shall be paid to her after oocyte donation.

10. The Donor agrees to accept the above amount and thereafter makes no other
demands for the donation of oocyte by her.

11. The Bank and the Donor agree to abide by all the relevant provisions of
Chapters V and VII, relating to sourcing, storage, handling and record
keeping for gametes, embryos and surrogate, and rights and duties of
patients, donors, surrogates and children, respectively, of the ART
(Regulation) Act.

12. This agreement is signed by both the parties after a clear understanding of all
the issues involved, and in full senses and under no pressure from any
person.

___________________________
___________________________

___________________________
___________________________

First Part Second Part

___________________________
___________________________

___________________________
___________________________

Witness 1 Witness 2

Name, address and telephone number of the witnesses:

121
 FORM - R (2)

Contract between the Semen Bank and the Surrogate

(See Rule 15.1)

The Semen Bank and the Surrogate Mother agree to come into this contract today
on the __________ day of _____________ month, 2008, in _________________ as
per the following conditions.

First Part being the __________________________ semen bank, having its office
at __________________ , and the registered office at _______________________,
herein referred to as the Bank (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Bank);

And

Second Part being Ms. __________________________________, aged ________,

residing at __________________________________________________________
_________________________________________________________________
hereinafter referred to as the Surrogate (which expression shall, unless repugnant to
the context or meaning thereof, be deemed to mean and include legal
representatives, administrators, etc., of the said Clinic)

Whereas

1. The first part is a semen bank that is established, amongst other purposes, to
screen and identify sperm / egg donors and surrogates, and store gametes.

2. The second part is an individual who has willingly agreed to be a surrogate

mother against a consideration from the individual(s) [to be herein after called
parent(s)] identified by the Bank.

3. That the Bank and the Surrogate have therefore come to form this contract to
facilitate the process with the laid down terms and conditions.

122
NOW THIS INDENTURE WITNESSETH THAT:

1. The Bank agrees to treat the second part as the surrogate mother for the
parent(s), _____________________ and ______________________. The
Surrogate agrees to be a surrogate mother for the child of the above parent(s)
identified by the Bank.

2. The Bank agrees to carry out on the Surrogate the needful precautionary tests
required before the process of ART and the Surrogate agrees to undergo
these tests, like for HIV and hepatitis B and C. Bank shall provide to the
surrogate reliable documentary evidence that the genetic parents have
undergone the necessary tests like for HIV, hepatitis B and C and that the
results are negative.

3. The Bank has explained the process of treatment to be undergone by the

Surrogate and the Surrogate has understood the treatment accordingly and
has, after such understanding, agreed to the surrogacy.

4. The Surrogate agrees to bear the child for the pregnancy period and then
handover the child born, to the parent(s). The surrogate clearly understands
that the consideration for the surrogacy is to be paid by the parent(s) and the
Bank will not be responsible for any demand by the surrogate in the form of
compensation. The Bank shall also not be responsible for payment to the
surrogate for any other expenses incurred during the surrogacy period.

5. The Surrogate assures the Bank that she will not undergo any sex
determination test for the child during pregnancy.

6. The surrogate shall be under the observation of the ART Clinic chosen by the
patient(s) during the period of the surrogacy. However, if any complications
arise during the period, the ART Clinic / Bank shall not be responsible for
them under any circumstances.

123
7. The Bank shall maintain all secrecy regarding the surrogacy and agrees not to
disclose any information in this regard to anyone without the consent of the
surrogate.

8. The Surrogate agrees to enter into an agreement with the parent(s), and to
file an authenticated copy of the agreement with the Bank as well as with the
ART Clinic.

9. The Surrogate agrees not to undergo embryo transfer for the parent(s) unless
the Bank gives her a green signal to do so.

10. The surrogate agrees to inform the Bank about the result of the pregnancy.

11. Both the Surrogate and the Bank agree to abide by all the relevant provisions
of Chapters V and VII on sourcing, storage, handling and record keeping for
gametes, embryos and surrogate, and rights and duties of patients, donors,
surrogates and children, respectively, of the ART (Regulation) Act, and Rule
15.2 (Form J) of the Rules and Regulations of the above Act.

12. Both the parties have entered into this agreement without any pressure on
either side and in their full senses.

_________________________ ________________________
_________________________ ________________________
First Part Second Part

__________________________ ________________________
__________________________ ________________________

Witness 1 Witness 2

Name, address and telephone number of the witnesses:

124
 FORM - S

Contract between the Semen Bank and the Patient

(See Rule 15.1)

The semen Bank and the Patient agree to come into this contract today on the
_____________________ day of _______________ month, 2008, in __________
as per the following conditions.

First Part being ____________ semen bank, having its office at

_______________________, and the registered office at ___________________,
hereinafter referred to as the Bank (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc. of the said Bank);

And

Second Part being Shri / Kum. / Smt. ___________________________ aged

___________, residing at____________________________________________
__________________________, and Shri / Kum. / Smt. ______________________
aged _________, residing at ____________________________________________
_________________________________________________________________,
herein referred to as the Patient (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Patient.

Whereas

1. The first part is a semen bank that is established to screen and identify sperm
/ oocyte donors and surrogates and to store gametes.

2. The second part is an individual / couple who has approached the Bank for
availing the services of a sperm / oocyte donor or as surrogate.

125
3. That the Bank and the Patient have, therefore, come to form this contract to
facilitate the process with the laid down terms and conditions.

NOW THIS INDENTURE WITNESSETH THAT:

1. The Bank agrees to supply the semen / oocyte donor / surrogate selected
by the patient to the ART clinic (registration no._______________) selected
by the patient as per the rules laid down in the ART (Regulation) Act.

2. The Bank agrees to disclose to the Patient all the information it has and is
required to have as per the rules laid down in the ART (Regulation) Act, about
the sperm / oocyte donor or surrogate (except the identity including name
and address and any information that would allow the identity to be revealed,
of the gamete donor). However, if any such information, or lack of any other
information causes any damage to the ART procedure or to the patient, then
the Bank will not be responsible for it.

3. The Bank agrees to inform the Patient about the result of all the tests carried
out on the donor at the initiative of the Bank.

4. The patient agrees to pay the Bank a sum of Rs._____________ for the
provision of each semen sample / oocyte donor / surrogate mother selected
by the patient.

5. The Bank agrees to accept the above amount and thereafter make no other
demands for the provision of donor sperm / oocyte donor / surrogate mother.

6. The patient agrees not to make any attempt to find out the identity of the
sperm or oocyte donor.

7. The Bank and the Patient agree to abide by all the relevant provisions of
Chapters V and VII, relating to sourcing, storage, handling and record
keeping for gametes, embryos and surrogate, and rights and duties of

126
 patients, donors, surrogates and children, respectively, of the ART
(Regulation) Act.

8. This agreement is signed by both the parties after a clear understanding of all
the issues involved, and in full senses and under no pressure from any
person.

______________________________ ________________________

______________________________ ________________________
First Part Second part

______________________________ ________________________

______________________________ ________________________
Witness 1 Witness 2

Name, address and telephone number of the witnesses:

127
 FORM - T

Contract between the Semen Bank and the ART Clinic

(See Rule 15.1)

The Semen Bank and the ART Clinic agree to come into this contract today on the
______________ day of ____________________ month, 2008, in
_______________ as per the following conditions.

First Part being ________________ semen bank, having its office at

_________________, and the registered office at ___________________________
__________________________________________________________________ ,
herein referred to as the Bank (which expression shall unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Bank);

And

Second Part being _________________ ART clinic having its clinic at

___________, and the registered office at ________________________________
__________________________________________________________________,
herein referred to as the Clinic (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the said Clinic)

Whereas

1. The first part is a semen bank that is established to screen and identify sperm
/ egg donors and surrogates and to store gametes.

2. The second part is a clinic working on infertility using various methods of ART
(Assisted Reproductive Technologies).

128
3. The Bank would identify and / or preserve the things mentioned in para 1 and
the clinic would use them to carry out the ART procedures.

4. The Bank and the Clinic have, therefore, come to form this contract to
facilitate the use of ART by the needy people with the laid down terms and
conditions.

NOW THIS INDENTURE WITNESSETH THAT:

1. The Bank agrees to do its best to provide the Clinic the kind of items
mentioned above (semen, oocytes/oocyte donors, and surrogates) as and
when required and in as many number as necessary.

2. The Clinic agrees to give the proper consideration for the use of the items
taken from the Bank as per the rates mutually decided between the parties
from time to time, and put on record.

3. The Bank shall ensure that the sperm / egg donor is free from HIV and
hepatitis B and C, infections, hypertension, diabetes, sexually transmitted
diseases, and identifiable and common genetic disorders such as
thalassemia.

4. The Bank shall have an analysis carried out on the semen of the individual,
preferably using a semen analyzer, and only the semen certified to be normal
according to WHOs specification shall be provided to the ART Clinic

5. The blood group and the Rh status of the individual shall be determined and
placed on record by the Bank.

6. Other relevant information in respect of the donor such as height, weight, age,
educational qualifications, profession, colour of the skin and the eyes, record
of major diseases including any psychiatric disorder, the family background in
respect of history of any familial disorder, criminal record, and religion, shall
be recorded by the Bank in an appropriate proforma.

129
7. On request for semen by the clinic, the Bank shall provide the Clinic with a list
of donors (without the name or the address but with a code number) giving all
relevant details as mentioned above.

8. The Clinic shall inform the bank about a successful clinical pregnancy and any
successful birth that the Clinic comes to know of.

9. The Clinic shall use any item obtained from the Bank only for the specific
purpose for which it was obtained.

10. The Bank or the Clinic shall not be responsible for the false report of any
appropriately accredited laboratory for any specific tests.

11. The Clinic and the Bank shall ensure that all the provisions of Chapters IV, V
and VII pertaining to the duties of an ART clinic, sourcing, storage, handling
and record keeping for gametes, embryos and surrogates, and rights and
duties of patients, donors, surrogates and children, respectively, are followed.

12. In case of any dispute between the Bank and the Clinic, the arbitrator
appointed by the parties jointly shall resolve the dispute.

___________________________ ___________________________

First Part Second Part

___________________________ ___________________________

Witness (1) Witness (2)

Name, address and telephone number of the witnesses:

130
 FORM - U

Contract between the Patient and the Surrogate

(See Rule 15.1)

The patient and the Surrogate mother agree to come into the contract today on the
_____________________ day of ________________ month, 2008, in
____________________ as per the following conditions.

First Part being the party [individual / couple, that may or may not be the genetic
parent(s) of the child to be born] seeking surrogacy, herein referred to as the patient,
Mr __________________________________, aged __________ , residing at
___________________________________________________________________
__________________________________________________________________
and / or Ms ______________________________________, aged ___________,
residing at __________________________________________________________
_____________________________________________________________ (which
expression shall, unless repugnant to the context or meaning thereof, be deemed to
mean and include legal representatives, administrators, etc., of the said party);

And

Second Part being Ms._____________________________, aged ____________,

residing at __________________________________________________________
_______________________________________________________________,
herein referred to as the surrogate (which expression shall, unless repugnant to the
context or meaning thereof, be deemed to mean and include legal representatives,
administrators, etc., of the surrogate).

Whereas

1. The first part is the person(s) desiring surrogacy.

131
2. The second part is an individual who has willingly agreed to be the surrogate
mother for a child of the patient, against a consideration from the patient for
whom she has agreed to be the surrogate mother.

3. The patient and the surrogate have, therefore, come to form this contract to
facilitate the process with the laid down terms and conditions.

NOW THIS INDENTURE WITNESSETH THAT:

1. The patient has agreed to have the surrogate deliver a child for the patient
and the surrogate has agreed to do so after taking necessary consent from
her (the surrogates) husband.

2. The patient and the surrogate have agreed to abide by all the provisions as
applicable, of Sections 34 and 36 and Rule 15.1 (Form J) of the ART
(Regulation) Act.

3. As per the provision of Section 34.3 of the above-mentioned Act, the patient
has agreed to pay in all Rs. to the surrogate for delivering a child for
the patient, in addition to the other expenses as per Section 34.2 of the
above-mentioned Act. The surrogate agrees to accept the above amount for
bearing a child for the patient. The payment of the above amount shall be
made as follows:

1st instalment which will not be less than 75% of the total amount, of
Rs.. at the time of embryo transfer.

2nd instalment of Rs. at . months after the

embryo transfer, if the pregnancy is established.

3rd instalment of Rs. at the time of handing over the child to the
patient in the presence of two witnesses.

The above charges are for the first embryo transfer for the patient. If that
does not succeed, for each subsequent embryo transfer within six months of

132
 the first embryo transfer, the surrogate will receive (in addition to the payment
already made) 50% of the total price agreed to initially, to be paid as follows:

25% (of the total price) at the time of embryo transfer.

% at . months after the embryo transfer, if the pregnancy is

established.

% at the time of handing over the child as above.

4. If the patient is not a citizen of India, or is a citizen of India but not normally
resident in the city of residence of the surrogate, the following shall be the
point of contact for the surrogate:

Name:

Complete address:

Telephone: Office... Residence...., Cell

Fax:.

E-mail

5. In the case of the death or unavailability of the patient, I shall deliver the child
to the following in the given order:

(1) Name:
Address:
Telephone: OfficeResidence:Cell:
Fax::
E-mail:

(2) Name:
Address:
Telephone: OfficeResidence:Cell:
Fax::
E-mail:

133
 The written consent of the above is attached. The above persons shall be
legally bound to accept the child in case of the death or unavailability of the
patient, when I am ready to deliver the child as per medical advise. They shall
keep me informed of any change in address till I deliver the child to the patient
or any one of the above.

5. The patient and the surrogate have willingly come to sign this agreement in
full senses and without any pressure from any person.

___________________________ ___________________________

First Part Second Part

___________________________ ___________________________

Witness (1) Witness (2)

Name, address and telephone number of the witnesses:

134
 Form - V

Oath of Secrecy
(See rule 15.1)

I, , Chairman/Member of , or
a member of the staff of ART clinic/semen bank, with registration no.*,
hereby declare on oath that I shall not disclose any information pertaining to a
patient (seeker of gamete donation, or of a surrogate mother) or to a gamete donor
or surrogate mother, to which I may have access, to anyone at any time, without
the permission of the patient, donor or the surrogate mother, as appropriate, except
when asked by a Court of Law to do so. I understand that I will be liable to
prosecution if I violate the above declaration.

Date: Signature
Place: (Name)

Address:

Signature of witness 1 Signature of witness 2

(Names, addresses, and telephone numbers of the witnesses)
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