PCOS

PCOS

Polycystic Ovary Syndrome (PCOS)



Which is the most common hormone disorder found in women?


PCOS  is extremely prevalent and probably constitutes the most frequently encountered endocrine (hormone) disorder in women of reproductive age. Having the disorder may significantly impact the quality of life of women during the reproductive years, and it contributes to morbidity and mortality by the time of menopause.


What are the disorders associated with PCOS?


Polycystic ovary syndrome women are at increased risk for coronary heart disease and type 2 diabetes mellitus. Their risk factors include central obesity, hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol, hypertension, and elevated fasting plasma glucose concentrations. Polycystic ovary syndrome women should undergo screening for hypertension, abnormal lipid profiles, insulin resistance, and reproductive disorders including cancer of endometrium.


What is PAO?


A subgroup of women (up to 30%) may have subtle abnormalities resembling Polycystic ovary syndrome  called PAO. While PCOS occurs in at least 5% of the population, the isolated finding of polycystic-appearing ovaries (PAO), which meets the classic ultra-sonographic criteria, occurs in 16–25% of the normal population without evidence of the full-blown syndrome. These characteristics include androgenic ovarian responses to stimulation with gonadotropins, as well as metabolic changes such as lowered high density lipoprotein-C levels and evidence of insulin resistance. While these data generated by our group need further assessment, these findings suggest that important yet silent abnormalities may exist in otherwise normal women who have a trait of Polycystic ovary syndrome (namely PAO).


What is the most important reproductive concern in women with PCOS?


The most frustrating reproductive concern for women with PCOS is pregnancy loss. The spontaneous abortion rate in Polycystic ovary syndrome is approximately one third of all pregnancies. This is at least double the rate for recognized early abortions in normal women (12–15%). Reasons for this are unclear although hypotheses include elevated LH levels, deficient progesterone secretion, abnormal embryos from atretic oocytes, and an abnormal endometrium.


How PCOS negatively impact psychosocial development of young women?


Women with PCOS, particularly those with hirsutism, have an increased prevalence of reactive depression and minor psychological abnormalities. There is also evidence of increased psychological stress and an increased catecholamine response to provoked stress. The overall quality of life is decreased in hirsute women. The presence of hirsutism and menstrual irregularities, especially in younger patients, is extremely distressing and has a significant negative impact on their psychosocial development.


Which cancer has increased risk in women with PCOS?


Women with Polycystic ovary syndrome are at increased risk of endometrial cancer. Chronic unopposed estrogen exposure is probably the proximate risk factor. This may be confounded by obesity, hypertension, and diabetes, which are known correlates of endometrial cancer risk. It is imperative to screen all women with Polycystic ovary syndrome, even those who are considered too young to develop endometrial hyperplasia and carcinoma.


Can low grade inflammation be a risk factor of PCOS?


Women with Polycystic ovary syndrome have significantly increased CRP concentrations relative to those in healthy women with normal menstrual rhythm and normal androgens. Inflammatory marker like CRP concentrations is more with PCOS. It correlates with the degree of obesity and inversely with insulin sensitivity, although not with total testosterone concentrations.

PCOS

PCOS


Which is a better predictor of metabolic syndrome in PCOS?


Obesity, a key determinant of insulin concentrations, appeared to have an independent effect on risk for the metabolic syndrome. In Anovulatory Polycystic ovary syndrome women a waist circumference of >83.5 cm along with biochemical evidence of hyperandrogenism is a powerful predictor of the presence of metabolic syndrome and insulin resistance. Age and central obesity (waist-hip ratio/waist circumference) are better predictors of metabolic syndrome in women with Polycystic ovary syndrome compared to other parameters including BMI.


How Metformin helps in PCOS?


Metformin is the most thoroughly investigated insulin-lowering agent used to treat PCOS; it enhances insulin sensitivity in the liver, where it inhibits hepatic glucose production, and in muscle, where it improves glucose uptake and use.

The persistence of regular ovulatory menstrual cycles in the 6 months after the end of treatment demonstrates that metformin treatment provides lasting benefits. All girls maintain a BMI <25 kg/m2, and this can play a role in normal ovulation menstrual cycles.


What is the role of AMH in diagnosis of Polycystic ovary syndrome ?


Serum anti-Mullerian hormone (AMH), produced in the ovaries by small follicles, is usually elevated in women with PCOS and correlates with the severity of this syndrome. AMH plays an important role in inhibiting follicular development by decreasing the sensitivity of the follicles to FSH and by inhibiting granulosa cell aromatase. Serum AMH appears as a sensitive and specific parameter that predict Polycystic ovary syndrome than antral follicle count and ovarian volume.

 


What is the source of DHEA in Polycystic ovary syndrome ?


Serum DHEAS has been found to be elevated in some women with polycystic ovary syndrome  . In Polycystic ovary syndrome , it has been found that there are actually two different sources of androgens, the ovary and the adrenal. In women with PCOS, the theca cells are overactive and proliferate excessively, producing too much testosterone. Unfortunately, in 40-50% of women with PCOS, there is also another source of androgens, which is the adrenal glands. The adrenal glands produce all of the DHEA in the body.


What causes PCOS in non-obese women?


All women with PCOS are not obese. Between 20–50% of women with PCOS are normal weight or thin, and the pathophysiology of the disorder in these women may differ from that in obese women. It has been suggested that PCOS develops in non-obese women because of a hypothalamic-pituitary defect that results in increased release of LH, and that insulin plays no role in the disorder.

These women tend to have an increased waist to hip ratio and are insulin resistant and hyperinsulinemic compared to their normal counterparts.


How the lean PCOS are treated?


Even normal weight and thin women with PCOS respond to pharmacological measures to improve insulin sensitivity, such as administration of agents like metformin, with decreases in ovarian androgen production and serum androgens. Administration of myoinositol (3 g per day) reduce luteinizing hormone (LH), high-sensitivity C-reactive protein (hs-CRP) (inflammation), and androgens, as well as improve insulin tolerance test, in lean patients with PCOS.


How infertility in PCOS treated?


 Lifestyle modification is very important in the treatment for PCOS, because weight loss and exercise have been shown to lead to improved fertility and the lowering of androgen levels. Ovarian stimulation along with insulin sensitizers help in many instances. IVF is an alternative option in Polycystic ovary syndrome . GnRH antagonist protocol appears to significantly reduce the rate of severe OHSS in these women. The average number of oocytes recovered is higher but rate of immature oocytes is more and fertilization rate is lower in the PCOS group.


Does IVM help in PCOS?


In-vitro maturation treatment can now be offered as a successful option to infertile women with polycystic ovaries or polycystic ovary syndrome. It is possible to combine natural cycle in-vitro fertilization with immature oocyte retrieval followed by in-vitro maturation, and thus offer women with various causes of infertility reasonable pregnancy and implantation rates without recourse to ovarian stimulation.


What is the effect of bariatric surgery in PCOS?


Bariatric surgery has been increasingly popular to treat morbid obesity associated with PCOS. In the larger population as the surgery has become safer with primarily a laparoscopic approach and selection of a healthier population for surgery, long-term survival is now superior with versus without the surgery.



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Infertility : When to see a doctor ?

Infertility : When to see a doctor ?

What should I Know before meeting a Fertility Specialist?

  • WOMEN – A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility.

When to see a doctor if you are a female patient?


You probably don’t need to see a doctor about infertility unless you have been trying regularly to conceive for at least one year. Talk with your doctor earlier, however, if you’re a woman and:

  • You’re age 35 to 40 and have been trying to conceive for six months or longer
  • You’re over age 40
  • You menstruate irregularly or not at all
  • Your periods are very painful
  • You’ve been diagnosed with endometriosis or pelvic inflammatory disease
  • You’ve had multiple miscarriages
  • You’ve undergone treatment for cancer

When to see a doctor if you are a male patient?


  • You have a low sperm count or other problems with sperm
  • You have a history of testicular, prostate or sexual problems
  • You’ve undergone treatment for cancer
  • You have testicles that are small in size or swelling in the scrotum known as a varicocele
  • You have others in your family with infertility problems

What are General factors responsible for infertility?


  • Diabetes mellitus,
  • thyroid disorders,
  • undiagnosed and untreated coeliac disease,
  • adrenal disease

What are environmental factors responsible for infertility?


Environmental factors

  • Glues,
  • Volatile organic solvents
  • Pesticides.
  • Tobacco smokers are 60% more likely to be infertile than non-smokers.

 What is the effect of age on fertility? 


  • Age.
    • WOMEN – A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility.
    • MEN -Men over age 40 may be less fertile than younger men .
  •  What is the effect of tobacco on fertility? 


    Smoking tobacco –

    • reduces the chances of pregnancy.
    • reduces the possible benefit of fertility treatment.
    • Miscarriages are more frequent in women who smoke.
    • Smoking can increase the risk of erectile dysfunction
    • low sperm count in men is common in tobacco use.

 What is the effect of tobacco on fertility? 


  • WOMEN -Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility.
  • MEN – Heavy alcohol use can decrease sperm count and motility.

 What is the effect of Weight on fertility? 


  • Overweight- Inactive lifestyle and being overweight may increase the risk of infertility.
    • WOMEN -Ovulation Disorders .
    • MEN – A man’s sperm count may also be affected if he is overweight so a normal weight is always healthy for fertility.
  • Underweight. Women at risk of fertility who follow a very low calorie or restrictive diet.So eat healthy foods and develop healthy habits .

What is the effect of Exercise on fertility? 


  • Exercise- Insufficient exercise contributes to obesity, which increases the risk of infertility.
  • Heavy Exercise – Ovulation problems are associated with frequent strenuous  and  intense exercise in women who are not overweight.Hence , it is important to avoid heavy exercise when you want to be pregnant.

What are infections associated with infertility?


  • Sexually transmitted infections 
  • chlamydia,
  • gonorrhea
  • Adeno-associated virus might have a role in male infertility so it is important to have a screening for these infections.


  • WOMEN – A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. 
  • MEN -Men over age 40 may be less fertile than younger men .


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HOW TO REDUCE RISK OF BREAST CANCER

HOW TO REDUCE RISK OF BREAST CANCER

HOW TO REDUCE RISK OF BREAST CANCER



Healthy Habits and periodical screening can Prevent Breast Cancer.

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Healthy Habits Prevents Breast Cancer.

Screening mammography can be done every year for women starting from age  40 to reduce risk of breast cancer

What is the relation of breast cancer with alcohol drink?


The more alcohol you drink, the greater your risk of developing breast cancer. Hence ,  stop or reduce your alcohol quantity that reduces your risk of breast cancer.

What is the relation of smoking and breast cancer risk ?


Smoking increases breast cancer risk. Hence , Stop smoking that keeps you healthy.

Is there a relation between weight of a person and breast cancer risk ?


Overweight is a risk factor for breast cancer. Overweight women has increased  risk of breast cancer.

How physical activity helps to reduce breast cancer risk ?


Physically active people maintain a healthy weight, which helps to reduce the risk of breast cancer.

What is the type of physical exercise helps to maintain a healthy weight and decrease the breast cancer risk ?


For a healthy life healthy weight is essential . Hence , You can observe the following for a healthy weight :

  • At least 150 minutes a week of moderate aerobic activity  or
  • 75 minutes of vigorous aerobic activity weekly

One of the above with  strength training at least twice a week keeps you healthy.

Is there a role of breast feeding in prevention of breast cancer?


Breast-feeding play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect. So breast feeding to the baby reduces the risk of breast cancer too.

What is the effect of hormone therapy on risk of breast cancer?


Combination hormone therapy for more than three to five years increases the risk of breast cancer. Hence be careful while on long term hormone therapy. Is it really necessary ?

You should screen yourself for breast cancer by consulting the doctor.

What is the role of radiation exposure/CT Scan in Breast cancer?


Some studies showed relation between between breast cancer and radiation exposure so it is better to reduce your exposure to radiation.

Which diet reduces risk for breast cancer?


Mediterranean diet with extra-virgin olive oil and mixed nuts may  reduce the risk of breast cancer in women.

Fruits ,vegetables, whole grains, legumes and nuts are healthy for your body and also reduces the risk of breast cancer.

Hence , healthy diet including vegetables, fruits and nuts with loads of antioxidants reduces the risk of breast cancer.

Is there a relation between birth control pills and breast cancer?


Birth control pills and intrauterine devices (IUDs) increases the risk of breast cancer due to the hormone in it. Risk is  estimated to be very small . The risk decreases after the medicine is stopped . As there is a small risk of breast cancer for people taking hormone therapy, you should be vigilant about breast cancer screening. If you find any mass oin breast then immediately consult the doctor.

What is the role of family history in Breast cancer ?


Genetics is  the primary cause of 5–10% of all cases. So women with family history of breast cancer to the mother should be vigilant about breast cancer detection.

When you should suspect breast cancer ?


Appearance of new lump or mass in the breast needs a screen and consultation of doctor. If you develop some skin changes over breast always consult the doctor.

Mass or lump in the breast , is it always indicates cancer?

No.

There are a number of benign conditions which can cause mass or lump in the breast and these issues can be solved by medicines or may need a small surgery. Hence , never get scares if you find a mass or lump in a breast, consult the doctor.

SCREENING FOR BREAST CANCER


What is the common screening for breast cancer?


Mammograms are the commonly used for  screening for breast cancer and early diagnosis too.

What is mammography ?


Mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer in early stages .This can detect the breast cancer before women experience any symptoms . At this point the disease is mostly treatable  so  the patient can have a healthy life further .

When I should have a screening mammogram ?


Mammography helps in early detection of breast cancers .

Mammography can show changes in the breast up to two years before it can be detected clinically.

Current guidelines from the U.S. Department of Health and Human Services (HHS) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.

Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.



Current guidelines from the U.S. Department of Health and Human Services (HHS) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.

Healthy Habits Prevents Breast Cancer.

Screening mammography: every year for women starting from age  40  reduce risk of breast cancer . Healthy habits including breast feeding reduces the risk of breast  cancer .

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Surrogacy In India – A Technology Impasse

Surrogacy In India – A Technology Impasse

Surrogacy is a method of assisted reproduction that helps biological parents start families when they cannot conceive naturally or by artificial methods. Couples pursue surrogacy for several reasons and come from different backgrounds.

There are two types of surrogacy arrangements: gestational surrogacy and traditional surrogacy. In gestational surrogacy, an egg is removed from the biological mother or an anonymous donor and fertilized with the sperm of the biological father or anonymous donor. The fertilized egg, or embryo, is then transferred to a surrogate who carries the baby to term. The child is thereby genetically related to the woman who donated the egg and the father or sperm donor, but not the surrogate. In a traditional surrogacy arrangement, a surrogate becomes pregnant with the use of her own eggs. Indian government legalised surrogacy in 2002 and from then gestational surrogacy is practiced in India.

GUIDELINES FOR SURROGACY –

  • The ART clinic or Fertility Hospital must not be a party to any commercial element in donor programmes or in gestational surrogacy.
  • A surrogate mother carrying a child biologically unrelated to her must register as a patient in her own name. While registering she must mention that she is a surrogate mother and provide all the necessary information about the genetic parents such as names, addresses, etc.
  • She must not use/register in the name of the person for whom she is carrying the child, as this would pose legal issues, particularly in the untoward event of maternal death (in whose names will the hospital certify this death?).
  • The birth certificate shall be in the name of the genetic parents. The clinic, however, must also provide a certificate to the genetic parents giving the name and address of the surrogate mother.
  • Surrogacy by assisted conception should normally be considered only for patients for whom it would be physically or medically impossible/ undesirable to carry a baby to term.
  • Payments to surrogate mothers should cover all genuine expenses associated with the pregnancy. Documentary evidence of the financial arrangement for surrogacy must be available. The ART centre should not be involved in this monetary aspect.
  • A third-party donor and a surrogate mother must relinquish in writing all parental rights concerning the offspring and vice versa.
    A child born through surrogacy must be adopted by the genetic (biological) parents unless they can establish through genetic (DNA) fingerprinting (of which the records will be maintained in the clinic) that the child is theirs.
  • A prospective surrogate mother must be tested for HIV and shown to be seronegative for this virus just before embryo transfer. She must also provide a written certificate that (a) she has not had a drug intravenously administered into her through a shared syringe, (b) she has not undergone blood transfusion; and (c) she and her husband (to the best of her/his knowledge) has had no extramarital relationship in the last six months.
  • No woman may act as a surrogate more than thrice in her lifetime
  • 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.
  • A surrogate mother should not be over 45 years of age. Before accepting a woman as a possible surrogate for a particular couple’s child, the ART clinic must ensure (and put on record) that the woman satisfies all the testable criteria to go through a successful full-term pregnancy.

Surrogacy Rules and Regulations in India

2002 – gestational surrogacy allowed in India

2008- Commercial surrogacy allowed

2012- India bars foreign gay couples, singles from surrogacy

2016-Bill to Ban Commercial Surrogacy Introduced In
Lok Sabha, Bill is still under discussion.

No Visas to Foreigners Wanting to Visit India For Surrogacy

Surrogacy Should Be Allowed Only for Indian Couples, Government Says

2018- Central government’s women employees, whose children are born through surrogacy, will now be entitled to maternity leave, according to an official order of the personnel ministry.

Discussion on surrogacy bill

In August 2017, the Parliamentary Standing Committee submitted its 102nd report on the Surrogacy Regulation Bill, 2016.

The report gives a clause by clause analysis of the Bill. In it, the Committee has pointed out certain pertinent observations which clearly indicate the draconian nature of the Bill, which is based on impractical and paternalistic presumptions.

Traditional surrogacy or gestational surrogacy?

One of the biggest and most prominent drawbacks is the contradiction in the Bill with respect to whether traditional surrogacy is allowed or gestational surrogacy. Traditional surrogacy is one where the egg of the surrogate mother and the intended father’s sperm is used to conceive the child with the help of IVF technology. It is the most widely practised forms of surrogacy.

However, it has been widely criticised due to the genetic link with the surrogate mother, which can lead to several emotional complications for the parents. On the other hand, gestational surrogacy – also referred to as “full surrogacy” – is the case where the egg and sperm are of the commissioning parents and the surrogate mother carries the fertilised egg of the intended parents. Thus, all of the genetic material involved originates either from the intended parents or donors.

The Surrogacy Regulation Bill, 2016, under Section 4 (iii) (b) (III) lays down: “No women shall act as a surrogate mother or help in surrogacy in any way, by providing gametes or by carrying the pregnancy, more than once in her lifetime.”

The effect of this provision under the bill is that the surrogate mother can provide her gametes and be a surrogate as well. On this, the Standing Committee opined that, “… on the one hand the Department asserts that only Gestational surrogacy is permitted under the Bill, whereas clause 4(iii)(b)(III) advocates the concept of Traditional Surrogacy. Thus, there is an apparent contradiction between the Department assertions and provisions of clause 4(iii)(b)(III). The Committee, therefore, recommends that the infirmity in clause 4(iii)(b)(III) be rectified and the clause be amended suitably so as to spell out in unambiguous terms that the surrogate mother will not donate her eggs for the surrogacy.”

The object of the Bill is to prevent exploitation, PREVENT COMMERCIAL SURROGACY-

However, this very basic provision if not rectified can lead to the opening of a Pandora’s box, especially since the current Bill provides that surrogacy can only be performed by a “close relative”. The emotional stress and complications of having a close relative as a surrogate, on the life of the surrogate child, surrogate mother and the commissioning parents, is immeasurable.

Close relative as a surrogate

The Committee has very beautifully dealt with the issue of “close relative” being a surrogate. The object of this provision was to curtail exploitation of the surrogate; however, it would be unrealistic and very complex. The provision can be analysed from two perspectives. First and foremost, infertility is a taboo in India and for couples to come forward and undergo Artificial Reproductive Technique (‘ART’) procedures and surrogacy procedures is frowned upon. In such a situation, to force couples to only be able to have close relatives as surrogates is arbitrary and violative of their basic reproductive rights.

Second, in the context of the surrogate mother, it would be unfair for her to have to see the child repeatedly, and the effect the same would have on the child is a different matter of concern altogether. The Committee has recognised these factors and suggested that “limiting the practice of surrogacy to close relatives is not only non-pragmatic and unworkable but also has no connection with the object to stop the exploitation of surrogates envisaged in the proposed legislation.

“The Committee, therefore, recommends that this clause of “close relative” should be removed to widen the scope of getting surrogate mothers from outside the close confines of the family of the intending couple. In fact, both related and unrelated women should be permitted to become a surrogate.”

Waiting period 5 years before commissioning surrogate-

ART and surrogacy procedures have emerged essentially due to increasing infertility in the society. The current Bill defines infertility as the inability to conceive after five years whereas the previous draft Bills, of 2008 and 2014, defined it as the inability to conceive after one year.

The Committee has compared this definition of infertility with that given by the WHO and suggested that “since conception has many interplay functions, a five-year time bar would add to the misery of already distressed intending couples. The five-year waiting period is therefore arbitrary, discriminatory and without any definable logic. The Committee, therefore, recommends that the definition of infertility should be made commensurate with the definition given by WHO. The words ‘five years’ in clause 2(p) and 4 (iii) (c) II, be therefore, replaced with ‘one year’ and consequential changes be made in other relevant clauses of the Bill.”

This suggestion by the Committee is based on the basic fundamental Right to Reproduction and the Right to Privacy. How and when individuals wish to reproduce is their own personal discretion. The government can impose limitations and set criteria, however, the same should be rational and not arbitrary.

Other suggestions

The Committee makes several other laudable suggestions, some of which take root from the previous ART Bills and some which are based on reasonable analysis of the current social-medical scenario. It suggested that ‘compensated surrogacy’ should be allowed and that single parents and live-in partners should be allowed to commission surrogacy.

Provision of breast milk banks

The Committee also recommended that there should be a provision of breast milk banks for the surrogate child, and a tripartite surrogacy agreement should be entered into between the parties instead of separate agreements, to make the process easier.

The Committee has analysed the bill in a very comprehensive manner and put forward suggestions which if not incorporated would have a domino effect and push the entire surrogacy industry underground, which in turn could lead to the exploitation of the all the members of the surrogacy arrangement. Surrogacy is undertaken by individuals to procreate and to found a family; the essence of that needs to be understood and retained.

COMMERCIAL SURROGACY

The parliamentary standing committee on health after examining the Surrogacy (Regulation) Bill 2016 has made a case to allow surrogacy on payment of money on the grounds that “economic opportunities available to surrogates through surrogacy services should not be dismissed in a paternalistic manner”.
The committee observed that if many impoverished women are able to provide their children with education, construct home, start a small business, etc. by resorting to surrogacy, there is no reason to take this away from them. While it is mandated that organ, donation should be altruistic, the committee has held that altruistic surrogacy was “extreme and entails high expectation from a woman willing to become a surrogate without any compensation or reward”.

The Union Cabinet, chaired by Prime Minister Narendra Modi, on 21 st March 18 gave approval for amending the Surrogacy (Regulation) Bill, 2016 to provide for rights of child born through surrogacy to that of a natural child or biological child and mandate for surrogacy clinics to be registered with the appropriate authorities in the states.

The amendments also seek 16 months of extended insurance coverage for the surrogate mother to cover all complications besides a strict clause to safeguard the surrogate mother from exploitation, the Union Health Ministry said.

Also, Assisted Reproductive Technology (ART) now has been kept out of the purview of the Bill, it added.

The proposed legislation ensures effective regulation of surrogacy, prohibit commercial surrogacy and allow altruistic surrogacy to the needy Indian infertile couples, as per an official statement.

Once it becomes the Act, it will regulate the surrogacy services in the country, control the unethical practices in surrogacy and prevent its commercialization of surrogacy. It will also prohibit potential exploitation of surrogate mothers and children born through surrogacy.

HOW EVER THE FERTILITY CONSULTANTS AND PROSPECTIVE CUSTOMERS ALL OVER INDIA ARE EAGERLY WAITING FOR THE LEGALISATION OF SURROGACY BILL ,AS FOR THE TIME BEING THE TECHNOLOGY IS AT STANDSTILL.

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