Enumerate the assisted reproductive technology (ART) procedures.

Understanding Assisted Reproductive Technology (ART)

ART encompasses a range of fertility treatments that involve handling both eggs and sperm, or embryos, outside the human body. These procedures are typically recommended when less invasive fertility treatments have been unsuccessful or when specific medical conditions necessitate direct intervention. The primary goal is to facilitate fertilization and embryo development, ultimately leading to a successful pregnancy.

Key Assisted Reproductive Technology (ART) Procedures

The main ART procedures are:

• In Vitro Fertilization (IVF): This is the most common and widely recognized ART procedure.
• Process: Eggs are retrieved from the woman's ovaries after ovarian stimulation, and sperm are collected from the male partner. Fertilization occurs in a laboratory dish. The resulting embryos are then monitored for several days.
• Embryo Transfer (ET): One or more viable embryos are transferred into the woman's uterus, with the aim of implantation and pregnancy.
• Indications: Blocked or damaged fallopian tubes, male factor infertility, endometriosis, unexplained infertility, and advanced maternal age.
• Intracytoplasmic Sperm Injection (ICSI): Often performed as part of an IVF cycle.
• Process: A single sperm is directly injected into the cytoplasm of an egg using a fine needle.
• Indications: Severe male factor infertility (e.g., very low sperm count, poor sperm motility, abnormal sperm morphology), previous failed IVF cycles with conventional fertilization, or when using surgically retrieved sperm.
• Gamete Intrafallopian Transfer (GIFT):
• Process: Eggs are retrieved from the ovaries and immediately mixed with prepared sperm. This mixture of gametes (eggs and sperm) is then directly transferred into the woman's fallopian tubes via laparoscopic surgery. Fertilization is intended to occur naturally within the fallopian tube.
• Indications: Primarily for couples with unexplained infertility or those with religious objections to in vitro fertilization (outside the body).
• Zygote Intrafallopian Transfer (ZIFT):
• Process: Eggs are fertilized with sperm in the laboratory (similar to IVF). However, instead of transferring the embryo to the uterus, the newly formed zygotes (fertilized eggs) are transferred into the fallopian tubes, typically within 24 hours of fertilization, also via laparoscopic surgery.
• Indications: Similar to GIFT, but offers confirmation of fertilization before transfer.
• Frozen Embryo Transfer (FET):
• Process: Embryos created during a previous IVF cycle, which were cryopreserved (frozen), are thawed and then transferred into the woman's uterus.
• Indications: If a fresh IVF cycle was unsuccessful, to avoid ovarian hyperstimulation syndrome, or for couples who wish to have more children after a successful fresh cycle without undergoing another full IVF stimulation.
• Third-Party Assisted ART (Donor Gametes/Embryos & Surrogacy):
• Sperm Donation: Utilized when the male partner has no sperm, severe genetic disorders, or for single women and same-sex female couples.
• Egg Donation: Used when the female partner has poor egg quality or quantity, premature ovarian failure, or genetic conditions.
• Embryo Donation: Involves using embryos donated by other couples who have completed their fertility treatment.
• Gestational Surrogacy: A woman carries a pregnancy for another person or couple, using eggs and sperm from the intended parents or donors. The surrogate has no genetic link to the child.
• Preimplantation Genetic Diagnosis (PGD) / Preimplantation Genetic Screening (PGS):
• Process: These are diagnostic techniques used in conjunction with IVF. A few cells are biopsied from an embryo (usually at the blastocyst stage) and tested for specific genetic disorders (PGD) or chromosomal abnormalities (PGS) before embryo transfer.
• Indications: Couples with a known risk of transmitting a genetic disease, recurrent miscarriages, or advanced maternal age.
• Intrauterine Insemination (IUI): While not strictly considered ART by some definitions (as it only involves sperm handling, not eggs or embryos directly manipulated outside the body), it is often a precursor to or used in conjunction with ART procedures.
• Process: Specially prepared (washed) sperm are directly inserted into the woman's uterus around the time of ovulation.
• Indications: Mild male factor infertility, unexplained infertility, or cervical mucus issues.

The Assisted Reproductive Technology (Regulation) Act, 2021

The Government of India enacted the Assisted Reproductive Technology (Regulation) Act, 2021, and its accompanying Rules in January 2022. This legislation aims to regulate and supervise ART clinics and banks, prevent misuse, and ensure ethical practices. Key provisions include:

• Establishment of National and State Boards for regulation.
• Mandatory registration of all ART clinics and banks.
• Regulation of gamete donation, including criteria for donors and protection of donor identity (confidentiality).
• Prohibition of sex selection and commercialization of embryos/gametes.
• Safeguarding the rights of the intending couple, donors, and children born through ART.
• Specifies eligibility criteria for commissioning parents (e.g., married heterosexual couples, single women who are widowed or divorced).

The Act represents a crucial step towards standardizing and ethicalizing the rapidly growing ART industry in India, addressing concerns about exploitation and ensuring responsible implementation of these advanced medical procedures.