Events of 2018-19

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Key Aspects
  • Any new lump should be investigated thoroughly (triple testing).
  • Irrespective of age , risk factors (family history, breast feeding) Every woman above 40yrs should get annual screening mammogram done.
  • Prior to any fnac or biopsy breast imaging must be done.
  • Axillary mass or lymph node should be investigated thoroughly to rule out breast pathology.
  • Always ask for family history of cancers in first degree relatives.
  • Offer genetic counseling in case there is positive family history (BRCA1,BRCA2).
  • According to the studies 90%of newly diagnosed breast cancers did not have any prior family history.
Medico legal aspects of infertility: RTM: sponsored by Abbott:

Take home messages :

Regarding consent:

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. (2.4)

  • No ART procedure shall be done without the spouse’s consent. (3.5.6)
  • There would be no bar to the use of ART by single women who wishes to have a child, and no ART clinic may refuse to offer its services to the above, provided other criteria mentioned in this document are satisfied. The child thus born will have all the legal rights on the woman or the man. (3.5.2)
  • Specific consent must be obtained from couples who have their gametes or embryos frozen, in regard to what should be done with them if he/she dies, or becomes incapable of varying or revoking his or her consent. (3.2.5)
  • The consent on the consent form must be a true informed consent witnessed by a person who is in no way associated with the clinic. (3.5.22)
  • Collection of gametes from a dying person will only be permitted if the widow wishes to have a child. (3.5.11)
Semen banking and rights for gametes:

A semen bank may store a semen preparation for exclusive use on the donor’s wife or on any other woman designated by the donor. ..... In the case of the death of the donor, the semen would become the property of the legal heir or the nominee of the donor at the time the donor gives the sample for storage to the bank. All other conditions that apply to the donor would now apply to the legal heir, excepting that he cannot use it for having a woman of his choice inseminated by it. (3.9.1.8

Third party reproduction :

  • A surrogate mother carrying a child biologically unrelated to her must register as a patient in her own name. (3.5.4)
  • An oocyte donor cannot act as a surrogate mother for the couple to whom the oocyte is being donated. (3.5.4)
  • Use of sperm donated by a relative or a known friend of either the wife or the husband shall not be permitted. It will be the responsibility of the ART clinic to obtain sperm from appropriate banks; neither the clinic nor the couple shall have the right to know the donor identity and address, but both the clinic and the couple, however, shall have the right to have the fullest possible information from the semen bank on the donor such as height, weight, skin colour, educational qualification, profession, family background, freedom from any known diseases or carrier status (such as hepatitis B or AIDS), ethnic origin, and the DNA fingerprint (if possible), before accepting the donor semen. It will be the responsibility of the semen bank and the clinic to ensure that the couple does not come to know the identity of the donor. (3.5.13)
  • 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. (3.10.6)
Sex selection:
  • Sex selection at any stage after fertilization, or abortion of foetus of any particular sex should not be permitted, except to avoid the risk of transmission of a genetic abnormality assessed through genetic testing of biological parents or through preimplantation genetic diagnosis (PGD). (3.5.9)

No ART clinic shall offer to provide a couple with a child of the desired sex. (3.5.10)

Eligibility criteria for art

For a woman between 20 and 30 years, two years of cohabitation/ marriage without the use of a contraceptive, excepting in cases where the man is infertile or the woman cannot physiologically conceive. For a woman over 30 years, one year of cohabitation/marriage without use of contraceptives. Normally, no ART procedure shall be used on a woman below 20 years.(3.14.1)

Key message from cme on 28th April
  • adolescents are eligible for all contraceptives as used in adults
  • contraceptives having non contraceptive benefits should be highlighted
  • EC pill should be a part of contraceptive basket but should not be misused
  • while offering choices individualisation is the key
  • counselling to dispel myths and misconceptions will help in increasing compliance.
  • do not forget to discuss contraception at every opportunity in your clinical practice.
  • contraception after all is an individual choice and we should help her making one without coercion.
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