• পুরোনো ভাটিয়ালি

• প্রথম পাতা ... ৫০৯৫৫০৯৬৫০৯৭৫০৯৮৫০৯৯৫১০০৫১০১৫১০২৫১০৩৫১০৪৫১০৫৫১০৬৫১০৭৫১০৮৫১০৯৫১১০৫১১১৫১১২৫১১৩৫১১৪৫১১৫৫১১৬৫১১৭৫১১৮৫১১৯৫১২০৫১২১৫১২২৫১২৩৫১২৪৫১২৫৫১২৬৫১২৭৫১২৮৫১২৯৫১৩০৫১৩১৫১৩২৫১৩৩৫১৩৪৫১৩৫ ...শেষ পাতা
  (পুরোনো ভাটিয়ালির কিছু পাতায় লেখা পড়তে গেলে বাংলা ফন্ট banglaplain ইন্সটল করার দরকার হতে পারে)

• tan | ১২ জুন ২০০৬ ২০:২১ | 131.95.121.251
• HC Ïl®p¾V ÏLw‚aÑ®hÉ c¤M¡e¡ fËnÀ Bl a¡l Ešl ®c®M q¡y q®u ®Nm¡j! HM®e¡ ÏL AhØb¡ HaV¡C M¡l¡f ®k L¡N®S ÏQÏW ®m®M Hje ®m®i®ml Sea¡J Apq¡u HaV¡C?®k ®ke®aefËL¡®lZ ®j®u®cl Ïh®u Ïc®a q®h ®ke®ae ®m¡®Ll p®Â,f¡œ e¡ q®m a¡l i¡C®ul p®Â?f¡®œl¡ ®j®u ®cM®a H®p f¡œ£®L h¡Ïam L®l a¡l ®h¡e®L Q¡C®m,e¡Q®a e¡Q®a h¡fj¡ ®R¡®V¡®j®u®L Ïh®u ®ce j¡epÇj¡e Ïn®Lu a¤®m?
  Bj¡l d¡le¡ ÏR®m¡ BCÏV M¤®m k¡h¡l f®l A¿¹a AhØb¡V¡ M¡ÏeL hc®m®Rz
  e¡ÏL ÏQÏW¬®m¡ HC fÏœL¡ AÏgp jÉ¡e¤gÉ¡LQ¡l L®l?
  

• J | ১২ জুন ২০০৬ ২০:২১ | 84.73.114.97
• ®Mm¡ ®no!
  

• J | ১২ জুন ২০০৬ ২০:১৯ | 84.73.114.97
• Bh¡l ®N¡mz 3x1 Cu¡ýEEEEEEEE!
  

• J | ১২ জুন ২০০৬ ২০:১৯ | 84.73.114.97
• l¡hÏs-p¡®l¡®Nn¡e-OlS¡j¡C-Ïi®ƒ¡Ïlu¡-g¤Vhm-r£l ph ®Oy®V k¡®µRz ÏaeÏjÏeV HLØVÌ¡ V¡Cj Ïc®m¡z
  

• J | ১২ জুন ২০০৬ ২০:১৬ | 84.73.114.97
• Bh¡l ®N¡mz A®ØVÌÏmu¡ ÏS®a ®Nmz
  

• Arjit | ১২ জুন ২০০৬ ২০:১৬ | 128.240.229.3
• RÏs®uÏRz
  
  Ïcõ£l l¡hÏs j¡®e Bj¡®cl r£l, AÏa Oe, fË¡u öL®e¡, p®Â ®fÙ¹¡ h¡c¡jz
  
  Bl Ïcõ£l r£l j¡®e Bj¡®cl f¡®upz
  

• s | ১২ জুন ২০০৬ ২০:১৬ | 141.80.168.31
• ®k®aC kÏc f¡la¡j ®a¡ ¬l¦l f¡a¡u Sea¡®L f¤Ra¡R L®l ®h¡l Ll®a Bpa¡j e¡z
  

• tan | ১২ জুন ২০০৬ ২০:১৫ | 131.95.121.251
• BµR¡,L¡S¤hlÏg ÏL ÏSÏep? L¡S¤ ®cu¡ p®¾cn?
  

• s | ১২ জুন ২০০৬ ২০:১৫ | 141.80.168.31
• eÉ¡kÉ Lb¡ ÏL¿º AÏlÏSv I ®k hmm r£l j¡®e Bj¡®cl f¡®up Bl Ïcõ£l l¡hÏs j¡®e r£l ECb h¡c¡j-ÏfÙ¹¡z a¡q®m ÏL c¡ys¡m?
  

• J | ১২ জুন ২০০৬ ২০:১৫ | 84.73.114.97
• Jx! Ïcõ£l l¡hs£®a i¡a ®eC, h¡Â¡m£l r£®ll j®a¡ fÔ¡p h¡c¡j V¡c¡j, Bl "r£l" j¡®e ebÑ CÏäu¡l f¡®up, ®pV¡l p®Â l¡hÏs ¬ÏmJ e¡z ÏglÏe Bh¡l AeÉ ÏSÏepz njÑ¡ ÏL¿º ®penjÑ¡ eu, j¡®e h¡Â¡m£ euz h¡m£N” g¡yÏsl L¡®R ®c¡L¡e, ®N®mC ph ÏX®Vm f¡®hz
  

• tan | ১২ জুন ২০০৬ ২০:১৪ | 131.95.121.251
• I p¤®a¡ Ïc®u ÏjRÏl h¡yd¡®e¡ L®¾pÃV,l®p p¤®a¡ T¤Ïm®u Ïc®m a¡s¡a¡Ïs Ïœ²ØV¡m h¡y®d!
  

• tan | ১২ জুন ২০০৬ ২০:১২ | 131.95.121.251
• ®l¬m¡l l¡hÏs®a l¡Cp b¡L¡l ®a¡ Lb¡ e¡!
  

• J | ১২ জুন ২০০৬ ২০:১১ | 84.73.114.97
• A®ØVÌÏmu¡ ®N¡m®n¡d Lõ!
  

• J | ১২ জুন ২০০৬ ২০:১১ | 84.73.114.97
• VÉ¡e, HV¡ Bj¡®cl j¡Cä®pVz ®N¡ J J J J J m!
  

• s | ১২ জুন ২০০৬ ২০:১০ | 141.80.168.31
• ÏpÏL!!!!! Ïcõ£l l¡hÏs a¡l j¡®e Ïjó l¡Cp ECb h¡c¡j ÏfÙ¹¡!!!!! a®h njÑ¡l l¡hÏsV¡ ®L¡e S¡a£u? h¡P¡m£ e¡ Ïcõ£h¡Ïm? HC njÑ¡ ®L¡e ®cn£u njÑ¡? ®penÇjÑ¡? e¡ CEÏf h¡m¡ njÑ¡???? l¡hÏs QQÑ¡ Ll®a ÏN®u ®Oy®V O q®u ®Nm¡j ®a¡!
  

• J | ১২ জুন ২০০৬ ২০:০৯ | 84.73.114.97
• ®Mm¡ ®cM®a ®cM®a ÏmMÏR, fËQ¤l h¡e¡e i¤m q®µRz
  

• J | ১২ জুন ২০০৬ ২০:০৮ | 84.73.114.97
• JV¡ ®fÙ¹¡z
  Bl hÔVw ®ff¡l V¤L®l¡ V¤L®l¡ L®l c¤®d Q¤Ïh®u ®pC c¤d O¾V¡l fl O¾V¡ S¡m Ïc®m hÔÏVw ®ff¡®ll Jf®l p®ll ®mu¡l fs®a b¡®L; Lj c¤d ®hÏn plz ÏQ®h¡®m ®h¡T¡ M¤h nš²z aar®Z hÔVw ®ff¡l Bl p®l j¡M¡j¡ÏM q®u ®N®Rz ®c¡L¡®el HL L¡ÏlN®ll L¡R ®b®L H abÉ ®S¡N¡s Ll¡z
  

• tan | ১২ জুন ২০০৬ ২০:০৮ | 131.95.121.251
• E®ÒV¡V¡ q®m c¤frC m‹¡u ®h¬e£!
  pcÉ öem¡j HL X¡š²¡l jÏqm¡l ü¡j£ L¡S f¡e Ïe,h¡s£®a "AÉ¡V ®q¡j XÉ¡X" q®u h¡µQ¡®cl ®cM¡öe¡ J AeÉeÉ N¡qÑØbÉ L¡S L®lezjÏqm¡ X¡š²¡Ïl L®le,fup¡l Ai¡h ®eC, ÏL¿º m‹¡u pj¡®S j¤M ®cM¡e e¡,L¡æ¡L¡ÏV L®le M¤h OÏeù h央cl L¡®R,ÏaÏe pwp¡®ll HLj¡œ ®l¡S®N®l q®a Q¡e e¡,Q¡e ü¡j£ ®l¡SN¡l Ll¦eza¡lf®l kÏc C®µR qu ÏaÏe Ll®he,ÏL¿º ü¡j£ h¡s£®a l¡yd®Rh¡s®R, ÏaÏe HL¡ ®l¡S®N®l--HC iu¡eL ®l¡m Ïli¡pÑ¡m L¡l¦l pqÉ q®µR e¡!!!!
  
  

• Arjit | ১২ জুন ২০০৬ ২০:০৬ | 128.240.229.3
• Az ®pV¡ j®e e¡Cz
  
  l¡hÏs S¡uN¡ ÏiÏš®a Bm¡c¡ quz h¡P¡m£ l¡hÏs qm Oe ÏjÏø c¤®dl j®dÉ JC hÔÏVw ®ff¡®ll jae hÙ¹¤, ®j¡V¡ pl j®e quz Ïcõ£®a l¡hÏs qm HLcj Oe r£l, p®Â h¡c¡j-®fÙ¹¡ - ®pM¡®e JC p®ll jae ÏSÏep¬®m¡ ®eCz Bl r£l j¡®e qm f¡®upz
  

• s | ১২ জুন ২০০৬ ২০:০৩ | 141.80.168.31
• hÔÏVw ®ff¡l Bl pl ÏQh¡®mJ ag¡v dl¡ f®s e¡? ÏL jS¡c¡l!! Bl hm®m e¡ ®a¡ njÑ¡l l¡hÏsl Ef®l I ph¤S l®Pl ÏL Rs¡®e¡ b¡®L?
  

• tan | ১২ জুন ২০০৬ ২০:০৩ | 131.95.121.251
• p¡j¿¹a¡Ï¿»L j¡eÏpLa¡ fl®a fl®a BSJ, kaC hÏm pj¡e¡ÏdL¡l,L¡®S Be¡ M¤-E-h nš²!
  

• tan | ১২ জুন ২০০৬ ২০:০১ | 131.95.121.251
• A®fr¡Lªa Ïm®hl¡ml¡ fkÑ¿¹ cÏrZ£ fZ ®eJu¡ f¡œ®cl AÒf DoÑ¡ L®l, L¡lZ "hÉ¡V¡l¡ m¡M m¡M fZJ ®eu,X¡î¡J f¡u h¡s£ ®b®L!" L¡lZ HLÏV N¡yJ ÏL ®N¡l£ ®h± B®p,®p Ïhe¡ h¡LÉhÉ®u X¡h¡ h¡y®d,®hl¦h¡l pju ph ¬ÏR®u ®cu, S¤a¡ fÏl®u ®cu,p®å®hm¡ LÓ¡¿¹ hl Ïgl®m a¡l f¡ ®V®fz
  ®h®qÙ¹ q¡ÏjeÙ¹ q¡ÏjeÙ¹!!!!!
  

• J | ১২ জুন ২০০৬ ১৯:৫৯ | 84.73.114.97
• Ïh®uh¡s£®a A®eL pj®u hÔÏVw ®ff¡®ll l¡hÏs M¡Ju¡uz H„ÏfÏl®u¾pX l¡hÏs M¡C®u R¡s¡ JV¡ ®Qe¡ M¤h nš²z p®ll Ai¡®h JV¡ hÔVw ®ff¡l Ïc®u Ïl®fÔp L®lz q¡Ïah¡N¡®el ®j¡®s HLV¡ ÏjÏøl ®c¡L¡e ÏR®m¡ a¡®cl I c¤eÑ¡j ÏR®m¡z ®c¡L¡eV¡ HM®e¡ B®R ÏLe¡ S¡Ïe e¡z
  

• tan | ১২ জুন ২০০৬ ১৯:৫৭ | 131.95.121.251
• AbQ Ïc®el fl Ïce h¡wm¡ L¡N®S lÏhh¡®ll Cp¤®a f¡œl¡ "ÏnÏra¡ p¤¾cl£ NªqLjÑÏef¤Z¡ n¡¿¹üi¡h¡ pwp¡lj¤M£" f¡œ£ ®M¡y®SzE®ÒV¡ q®mC ®N®m¡ ®N®m¡ lh!!!!
  Bjl¡ Ïi®ƒ¡l£u O¡Nl¡ d®l T¤®m BÏR!
  

• tan | ১২ জুন ২০০৬ ১৯:৫৩ | 131.95.121.251
• Hl B®N HLÏce nj£L q¡Ep q¡phÉ¡®äl HLÏV Ïh‘¡f®Zl Lb¡ h®mÏR®m¡ ®kM¡®e f¡œ eV ECÏmw V¤ Ju¡LÑ a¡C ®l¡S®N®l ®j®u M¤yS®R Ïh®u Ll®a-HClLj ÏR®m¡ AÉ¡XV¡ jÉ¡ÏVÌ®j¡Ïeu¡m Lm¡®jz
  

• s | ১২ জুন ২০০৬ ১৯:৫৩ | 141.80.168.31
• njÑ¡l l¡hÏsl Ef®l ph¤S ph¤S l®Pl ÏL Rs¡u? ÏfÙ¹¡??? hÔÏVw ®ff¡l ®cJu¡ l¡hÏs ®L¡b¡u f¡Ju¡ k¡®h? ®M®u ®cMhz
  

• J | ১২ জুন ২০০৬ ১৯:৫২ | 84.73.114.97
• OlS¡j¡C®ul AÉ¡XV¡J nj£L Ïm®MÏR®m¡ ®hn ÏLR¤Ïce B®Nz
  

• Arjit | ১২ জুন ২০০৬ ১৯:৫১ | 128.240.229.3
• nj£L j®e qu OlS¡j¡C Cpɤ®a ®m®MÏez Ïm®M®R HL hE b¡L¡ p®ˆÄJ h¤L g¤Ïm®u Bl HLV¡ hE ®M¡yS¡l S®eÉ AÉ¡X ®c®M - öd¤j¡œ "h¡µQ¡ fuc¡ Ll¡l ®jÏne" AÉ¡ÏVÏQEX Ïe®u, Hhw Mh®ll L¡N®Sl ®pV¡®L fËnËu ®cJu¡ Ïe®uz
  

• J | ১২ জুন ২০০৬ ১৯:৪৭ | 84.73.114.97
• njÑ¡l l¡hÏs i¡®m¡z N¡Â¤l¡®jlV¡ M¡CÏez l¡hÏs HLV¤ p¡hd¡®e ®M®a quz A®eL ®c¡L¡®e l¡hÏs®a hÔÏVw ®ff¡l ®iS¡m Ïc®u h¡e¡®e¡ quz fl£Ïra paÉz
  

• J | ১২ জুন ২০০৬ ১৯:৪৪ | 84.73.114.97
• OlS¡j¡C®ul Le®pÃV ÏQlV¡L¡m d®lC i¡la£u pj¡®S ÏR®m¡ kÏcJ OlS¡j¡C®cl M¤h HLV¡ pÇj¡®el ®Q¡®M ®cM¡ q®a¡ e¡z OlS¡j¡C®ul ®c±m®a M¤h ®hn£ "S¡j¡C Bcl" S¤Va h®m j®e qu e¡z ÏqϾc Ïp®ej¡®aJ OlS¡j¡C®ul C®jS ApÇj¡eSeL, Ll¦Z Abh¡ q¡pÉLlz Ec¡qlZx c¡Ïje£ Ïg®Òj ÏVe¤ Be¾c, Q¡¾ce£ Ïg®Òj Ae¤fj ®Ml, CaÉ¡Ïcz
  ÏL¿º p¡ÇfËÏaL ®k Ïh‘¡f®el Lb¡ nj£L Ïm®M®R, a¡l p®Â VÌÉ¡ÏXne¡m OlS¡j¡C Le®p®ÃVl g¡l¡L B®Rz
  B®Nl Ïc®e OlS¡j¡C hm®a ®h¡T¡ ®ka de£ nÄöl, ®j®u®L M¤h i¡®m¡h¡®pe, OlRs¡ Ll®a Q¡e e¡ a¡C Nl£h Ol ®b®L HLÏV ®R®m®L H®e a¡®L ®j®ul p®Â Ïh®u Ïc®u O®l ®l®M ®cJu¡z ph c¡ÏuaÄ nÄö®llz ®j®u h¡ S¡j¡C L¡E®LC ®fV Q¡m¡®e¡l S®eÉ Ef¡SÑe Ll®a q®µR e¡z nÄöl qua Ïe®Sl pÇfÏšl Awn S¡j¡C®L Ïc®Re, ÏLwh¡ hÉhp¡®u f¡VÑe¡lÏnfz ®j®uÏV ÏL¿º Hph ®r®œ ®l¡S®N®l euz
  ÏL¿º HMeL¡l AÉ¡XÏV®a ®R®mÏV Ef¡SÑerj ®h± M¤yS®Rz HCV¡C Bj¡®cl j§mÉ®h¡®d BO¡a Ïc®u®Rz Bjl¡ d®l Ïem¡j ®R®mÏV L¤y®s, L¡S Ll®a Q¡u e¡, ®ke ®f±l¦®ol Ai¡h, q¡Ïpl ®M¡l¡Lz
  ®R®mÏV Ïh®ul pju Ef¡Serj b¡L®m Hhw f®l ®L¡®e¡ L¡l®Z f¤ q®u ÏN®u h¡ hÉhp¡u hÉ¡ˆl¡ÃV q®u ÏN®u h¡ Q¡Ll£l h¡S¡®l ®hL¡l q®u ÏN®u p¡l¡S£he ®h±®ul Jfl ÏX®f®ä¾V q®m Bj¡®cl ®Q¡®M ®p q¡Ïpl f¡œ q®a¡ e¡; Ll¦Z¡l f¡œ ÏLR¤V¡ q®a¡z
  Bjl¡ e¡l£ f¤l¦®ol CL¤u¡m l¡CV®pl Lb¡ h®m ®QyÏQ®u Nm¡ ÏQ®l ®gÏm, ÏL¿º f¤l¦o J e¡l£l HC p¡j¡eÉ Øb¡e ÏhÏeju Bj¡®cl ®Q¡®M HMeJ i£oZ "AX"z
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  HLV¡ ÏVÏi ÏpÏlu¡m q®a¡ Ïcõ£ c§lcnÑe ®b®L BÏnl cn®Ll ®N¡s¡u, "ÏjØV¡l AÉ¡ä Ïj®pp", lÏhh¡l c¤f¤®l ®cM¡®a¡z M¤hC q¡Ïpl ®M¡l¡Lz HLV¡ N¡eJ ÏR®m¡ ®pV¡ ®N¡s¡®a qa, fËÏaÏV HÏf®p¡®Xl B®N, a¡l ÏLR¤ ÏLR¤ në HlLj "..... M¡e¡ HL he¡®u, c¤S¡ cgal k¡®u..", hl c¤f¤®l l¡æ¡ h¡æ¡ Lla, ®h± AÏg®p ®ka, q¡Epq¡S®häz ®pC a¤me¡u "lSe£" ÏpÏlu¡mV¡ A®eL ®h¡ô ÏR®m¡z
  fyÏQn hRl f®lJ pj¡S ÏL B®c± hc®m®R?
  

• s | ১২ জুন ২০০৬ ১৯:৩১ | 141.80.168.31
• BµR¡, njÑ¡l l¡hÏs ®Lje ®ppÇf®LÑ haÑj¡e J fË¡š²e LmL¡a¡ h¡p£ Sea¡l L¡®l¡l ®L¡®e¡ d¡lZ¡ B®R? (®LE l¡N®he e¡ kÏc hÏm ®k BÏj njÑ¡l e¡jC öÏe Ïe)z p¤ü¡c¤ l¡hÏs k¡ ÏS®i ®N®mC j®e q®h Ïp®d ü®NÑ Hm¡j Hje Ae¤i§Ïal SeÉ LmL¡a¡l ®L¡e ÏjÏøl ®c¡L¡®e ®k®a q®h? N¡Â¤l¡®jl l¡hÏsC h¡ ®Lje? LmL¡a¡l l¡hÏs Ïho®u (m¡m¤ NªÏqe£ ee, EÏe hsC lpLoq£e, M¡Ju¡ k¡®h e¡) ®k k¡ f¡®le B®m¡Lf¡a Ll¦e n£OË n£OËz
  
  

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• HaV¡ ®V„V h¡wm¡u Ae¤h¡c Llh¡l ¯dkÑ ÏR®m¡ e¡z
  

• J | ১২ জুন ২০০৬ ১৯:০৬ | 84.73.114.97
• The Surrogate Option
  
  In many situations, a woman may want to have a child even when she is not physically capable of carrying her baby, usually due to the absence of the uterus or other medical problems. While some women are born without a uterus, the majority of women in this group have no uterus as a result of hysterectomy, a procedure that removes the organ for medical reasons. The next largest group of women not able to have children include those who have a disease which is known to worsen during pregnancy. In this case, pregnancy may threaten either the patient's or the baby's life.
  
  Surrogate parenting is an option for these women and their partners. There are two types of surrogate situations. One includes a surrogate who is inseminated with the husband's sperm, and who conceives with fertilization of her own egg. The surrogate gives birth to a child which is genetically half of hers and half of the husband's.
  
  The second type of in vitro fertilization surrogating occurs when the surrogate carries to term the embryo conceived by the wife's oocyte and the husband's sperm. The wife's egg is recovered through the usual in vitro fertilization process, and is transferred to the uterus of the surrogate to carry, nourish and deliver. This child does not have any genetic connection to the surrogate, frequently called gestational surrogate, who carried the pregnancy.
  
  The concept of surrogacy is not a new one. Surrogate mothers and intended parents can be traced back to the book of Genesis in the Old Testament. Abraham’s wife Sarah used her maid, Hagar, as her surrogate, and Isaac’s wife, Rachel, recruited her servant, Bilbah, to carry Isaac’s child. Commercial surrogacy began in the United States in the late 1970’s, when an attorney, named Noel Keane, arranged the first surrogate contract and started the first agency dedicated to surrogacy.
  There are three types of surrogate arrangements:
  Traditional Surrogacy using Artificial Insemination
  In this arrangement, the surrogate agrees to donate her eggs and to be artificially inseminated with the sperm of the intended father. Most states require the intended mother to do a step-parent adoption, after the birth of the baby, in order to establish her parental rights and to have the surrogate give up her rights to the child.
  Gestational Surrogacy
  In this arrangement, the surrogate agrees to carry the embryos made from the sperm and eggs of the intended parents. The offspring from this arrangement are the genetic child (ren) of the intended parents, and the surrogate functions as a “host” uterus. The surrogate in this arrangement may also be called a “gestational carrier.”
  Donor Egg/ Gestational Surrogacy
  In this arrangement, the surrogate agrees to carry the embryos made from the sperm of the intended father and the eggs from a third party donor (who may be known or anonymous). There is no biological tie to the surrogate, so she functions as a “host” uterus or “gestational carrier”.
  Since the 1970’s, there have been over 35,000 births as a result of surrogacy. Any condition that causes significant ovarian dysfunction can be an indication for surrogacy, while any condition that causes uterine or tubal damage can be an indication for gestational surrogacy. Medical conditions that threaten the mother’s life, or physical disabilities that impact a woman’s ability to carry a pregnancy, can also be indications for this reproductive option.
  Indications for Surrogacy/ Gestational Surrogacy
  Ovarian Dysfunction
  Advanced maternal age / menopause
  Premature ovarian failure
  Genetic disorders of the female partner
  Severe ovulatory disorders not remedied by therapy with fertility drugs
  Chemotherapy or radiation that has destroyed ovarian function
  Surgical menopause
  Uterine Dysfunction
  Severe endometriosis
  Hysterectomy
  Myomectomy (that may affect the uterus’s ability to hold a pregnancy to term)
  Severe endometritis or intrauterine scarring
  Congenital anomalies of the uterus
  Severe pelvic adhesions that distort the uterus or bowel
  Medical Conditions
  Severe cardiac or renal disease
  Brittle diabetes
  Active Disseminated Lupus Erythematosus
  Estrogen dependent cancers
  Conditions that require the female partner to take medications that are teratogenic
  Others
  Numerous failed IVF cycles for unexplained reasons
  History of ectopic pregnancies
  Physical disabilities that will be exacerbated by the weight gain of pregnancy
  Same sex couples
  Restrictive adoption policies that would disqualify a couple
  In most clinics, there must be demonstrated medical necessity to use a surrogate or carrier. The surrogacy arrangement requires the expertise of many professionals to run smoothly. Many arrangements are facilitated by an agency, who matches surrogates and intended parents.
  In addition to the staff of the fertility clinic, the couple and surrogate should be prepared to meet with a psychologist for screening and psychoeducational counseling and an attorney to draw up contracts between the parties. Finally, meetings with the obstetrician and hospital staff may also be preemptively arranged.
  There are two types of surrogates: compassionate and compensated. The compassionate surrogate is usually someone known to the couple. Compassionate surrogacy is done less frequently than compensated or recruited surrogacy. These arrangements may be known or anonymous and are often coordinated by agencies or attorneys who specialize in this field. These agencies pre-screen and exclude inappropriate candidates, anticipate the questions and concerns of the intended parents, facilitate and mediate potential areas of conflict, and help with the post-birth transition for both the surrogate and the intended parents.
  The pregnancy rates using surrogates are comparable to those with IVF. As in IVF the age of the female partner or traditional surrogate will impact success rates significantly. The limited data published in peer reviewed journals suggest no disadvantage to surrogacy as a reproductive option.
  References:
  Goldfarb J, Austin C, Peskin B, Lisbona H, Desai N, deMola J. Fifteen years experience with an in-vitro fertilization surrogate gestational pregnancy programme. Hum Reprod 2000; 15: 1075-8.
  Hanafin H. Overview of surrogacy parenting. [Internet]. Marietta (GA): TASC; c1999 [cited 2004 Dec 14]. Available from: http://www.surrogacy.com/psychres/article/eval.html.
  Jacobson A, Weckstein L, Galen D, Hampton K, Ivani K. High pregnancy rates with IVF surrogacy. [Internet]. Gurnee (IL): OPTS, Inc.; c 1997-2003 [cited 2004 Dec 14].
  Available from: http://www.opts.com/med4.htm.
  Stewart D. When should a couple consider surrogacy or a gestational carrier. [Internet]. Marietta (GA): TASC; c1999 [cited 2004 Dec 14]. Available from: http://www.surrogacy.com/medres/article/whenshou.html.
  The criteria used to screen potential gamete donors are critical to the success of the program. Screening affects the health of the donor, the recipient and the offspring. There are three components to donor screening and they include: (1) insuring that the donor will not incur undue physical or psychological risk, (2) insuring that the donor will not transmit infectious disease to the recipient, and (3) genetic screening to insure that there is no undue risk of the transmission of heritable diseases to the offspring.
  The physical assessment of donors is designed to screen for overall health, reproductive health and potential, infectious diseases, substance abuse and finally, genetically inheritable diseases. On May 25, 2004, the US Food and Drug Administration (FDA) became involved in the practice of gamete donation by publishing, “Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products,” in the Federal Register. The purpose of these rules is to make and enforce regulations necessary to prevent the introduction, transmission, or spread of communicable diseases. A partial overview of the rules follows.
  Categories of reproductive donors:
  There are three categories of reproductive donors subject to three different sets of requirements.
  1. Anonymous donor- to whom all relevant donor-eligibility screening and testing requirements apply. Anonymous semen donors must pass all screens and tests required under the new rule. A new test specimen from these donors must be collected at least six months after their semen donation and it must test negative for relevant communicable diseases in order for the semen donation to be eligible. The semen donation must be quarantined until this re-testing is complete.
  2. Directed reproductive donor- whose reproductive cells and tissue may be used even if the donor is determined ineligible. A directed donation involves the designation of a specific potential recipient, but does not involve a sexually intimate partner. The distinction was made between directed reproductive donors and anonymous donors to respect the existence of relationships between people who know each other and have made a joint decision for the recipient to conceive a child. Directed donations of semen are excepted from the six-month retesting requirement applicable to anonymous donations.
  3. Sexually intimate partner- for whom testing and screening are not required.
  Cryopreserved reproductive cells or tissues (sperm, eggs, or embryos) originally collected and stored for one’s own use or for use by a sexually intimate partner may later be used for a directed donation provided additional donations are unavailable and appropriate measures are taken to screen and test the donor(s) before transfer of the tissue to the recipient.
  Testing and Screening Requirements
  Screening
  Virtually all donors other than sexually intimate partners must be screened for risk factors and clinical evidence of communicable diseases. This screening requires a review of relevant medical records, including a donor medical history interview and physical exam. The screening for donors of reproductive cells or tissues must specifically address risk factors for, and evidence of:
  • HIV
  • Hepatitis B
  • Hepatitis C
  • Human transmissible spongiform encephalopathy, including Creutzfeldt-Jakob)
  • Treponema pallidum (syphilis)
  • Communicable disease risks associated with xenotransplantation (The surgical transfer of cells, tissues, or especially whole organs from one species to another)
  • Chlamydia trachomatis; and Neisseria gonorrhea
  In addition, donors of viable leukocyte-rich cells or tissue (which includes semen but not oocytes or embryos), also must be screened for:
  • Risk factors for relevant cell-associated communicable disease agents, including HTLV.
  Testing
  In addition to the screening described above, donor specimens must be tested in a CLIA certified (or CLIA-exempt) lab for certain communicable diseases. Virtually all donors of reproductive cells or tissues, other than sexually intimate partners, must be tested for the following:
  • HIV-type 1
  • HIV-type 2
  • Hepatitis B
  • Hepatitis C
  • Treponema pallidum
  • Chlamydia trachomatis; and Neisseria gonorrhea
  (Note: in the case of oocytes retrieved through non-vaginal laparoscopy, and therefore not exposed to the genitourinary tract, testing for chlamydia and gonorrhea is not required)
  Donors of viable, leukocyte-rich cells or tissue (which includes semen but not oocytes or embryos) also must be tested for:
  • HTLV-type I
  • HTLV-type II
  • CMV
  Timing of Testing
  Specimens for donor testing must be collected at the time of recovery of cells or tissues from the donor or, if this isn’t feasible, collection may be done up to 7 days before or after recovery. Donations from anonymous semen donors must be quarantined until donors are retested and again determined eligible at least 6 months after the date of donation. With respect to anonymous donation of embryos, a donor-eligibility determination must have been made for both the oocyte donor and the semen donor at the time the embryo was created.
  Quarantine Requirements
  Eggs and embryos need not be quarantined. However, semen must be quarantined for six months. The six-month quarantine requirement and the re-testing requirement apply only to anonymous semen donors. Also, you do not have to obtain a specimen for testing at each donation from a repeat anonymous donor, so long as the initial specimen was tested and you do not release any of the donations until after the donor has been retested at least six months post-donation.
  These rules are designed to protect the public and to increase public confidence in the new technologies. FDA representatives are authorized to make random inspections. Compliance is not voluntary and any person found to be in violation may be punished by imprisonment for up to one year and fined $100,000 if a death has not resulted, or up to $250,000 if a death has occurred. Organizational defendants can be fined up to $200,000.
  References:
  FDA Regulations on Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products. Available at: http://www.fda.gov/cber/rules/hctdnr.pdf.
  
  
  

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  [email protected]
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