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Ethics in Infertility treatment A study of practices in Allopathy and Siddha medicine

Ethics in Infertility treatment A study of practices in Allopathy and Siddha medicine. Dr.V.Jamuna Dr.Aruna Sivagami. Contents. Introduction Treatment / Procedures - Allopathic Practitioners Unethical Practices of Allopathic Medicine - Criticism

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Ethics in Infertility treatment A study of practices in Allopathy and Siddha medicine

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  1. Ethics in Infertility treatmentA study of practices in Allopathy and Siddha medicine Dr.V.Jamuna Dr.Aruna Sivagami

  2. Contents • Introduction • Treatment / Procedures - Allopathic Practitioners • Unethical Practices of Allopathic Medicine - Criticism • Treatment / Steps followed in Siddha System of medicine • Unethical Practices of Traditional Medicine – Criticism • Case History of successful patients treated through Siddha system of Medicine • Conclusion

  3. Introduction • Medical ethics is the discipline of evaluating the merits, risks and social concerns of activities in the field of medicine. • Six of the principles which in common doctors should consider while decision making. • Beneficence • Non- Malificence • Autonomy • Justice • Dignity • Truthfulness and honesty • This presentation focuses upon ethical and unethical medical practices in treating infertility amongst man and woman in India

  4. Infertility • Infertility is the inability to conceive after attempting to do so for 1 year. • It occurs in about 10%-15% of couples • It is a result of physiological problems in either partner • Increasing prevalence a cause for concern • Attributed largely to changes in lifestyle,environment and pollution.

  5. How big is it a problem? Source: American college of Obstetricians and Gynecologists

  6. MALE Azoozspermia Oligospermia Vas block Varicoceles Hormonal Deficiency Genetic disorders FEMALE Anovulation Fallopian tube block Endometriosis Hormonal Imbalance Anatomical abnormalities Genetic disorders Common Causes for Infertility

  7. Treatment / Procedures - Allopathic Practitioners • Male Infertility • Hormonal therapy to increase Sperm counts • Female Infertility (Ref. Novak’s Textbook of Gynecology ) • Medication to stimulate the ovaries to “ripen” and release eggs (e.g.: Clomiphene citrate) • Surgery to restore patency of obstructed fallopian tubes ( Tuboplasty ) • Artificial insemination which involves the woman being inseminated with Husband / donor sperm. • Invitro fertilization (IVF) in which eggs are removed from the woman, fertilized and then placed in the woman’s uterus bypassing the fallopian tubes.

  8. Treatment Options Exogenous • IUI • ICSI • Sperm extraction • GIFT • ZIFT

  9. Unethical Practices of Allopathic Medicine - Criticism • Adverse effects of supra-normal doses of hormones • False hopes to the patients • Low Percentage of Success of Tuboplasty & In vitro fertilization • High-cost treatments- out of reach for some couples • Legal status of embryos fertilized and not transferred • IVF’s have a higher percentage of Multiple pregnancies leading to Medical and Social problems for the Family

  10. Unethical Practices of Allopathic Medicine - Criticism (cont…..) • Psychological impact • Anxious to conceive – creates and worsened Marital discord • Clinical depression rates among Women undergoing Infertility treatment similar to those with Cancer or Heart disease. • Medications like Steroids & Anti-fungals known to cause Infertility • Surgical complications of Diagnostic procedures (Diagnostic laproscopy) • Birth defects are increased with the use of IVF in general and ICSI specifically.

  11. Ethical issues • Issues regarding Donor Insemination • Emotional turmoil of Father • Emotional turmoil of Child • Lack of paternal bonding by children • Legal issues regarding property rights, etc • Possibility of genetic disorders being transmitted through Donor insemination • Use of unauthorized Donor Insemination

  12. Ethical issues …..contd • Issues regarding Surrogacy • Joy of Motherhood – taken away • Risk of Fetal Well being due to surrogacy • Bio-ethical dilemmas in commercial surrogacy

  13. Emotional bonding between Mother & Child….!

  14. Treatment / Steps followed in Siddha System of medicine • Includes new combinations of herbal drugs not available in other systems • Aimed at providing a Healthy life and not just the cure of symptoms. • System based on “ Tridosha” – humoral theory akin to modern Endocrinology • System inculcates good cultural principles & moral conduct • System based on natural herbs and Ingredients rendering new impetus for stimulation of active life • Siddha Rx paves the way for restoration of the potency of obstructed fallopian tubes without any surgery.

  15. Treatment / Steps followed in Siddha System of medicine contd.. • Use of Herbal Medicines • Lifestyle changes • Dietary Changes • Eating in Clay vessels, Banana leaves • High fiber ,Low Cholesterol diet • Avoid preserved Foods • Personal habits • Smoking should be avoided • Complete avoidance of alcohol • Avoidance of Recreational drug use • Complete Avoidance of extra marital affairs or any other abnormal sexual activities • Use of cotton Garments [particularly inner wears] • Regular exercise in the form of walking or jogging…

  16. Treatment modalities –Endogenous(Ref. Indian Medicinal Plants, Arya Vaidya Sala ) Aloe indica Terminalia chebula Withania somnifera Phyllanthus niruri

  17. Treatment modalities –Endogenous(Ref. Indian Medicinal Plants, Arya Vaidya Sala ) Phyllanthus emblica Phylanthus reticulatus Piper longum Terminalia bellirica

  18. Treatment modalities –Endogenous(Ref. Indian Medicinal Plants, Arya Vaidya Sala ) Polyalthia longifolia Smilax china

  19. All the above mentioned points are rationally proven and not mere “BLIND BELIEFS”

  20. Unethical Practices of Traditional Medicine & Criticisms • Issues of compatibility between varieties of Traditional medicine & the scientific method • Lack of proper testing or Evidence based Medicine (EBM) • No Randomized Control trials • Safety aspects

  21. Ethical issues- Endogenous medicine • Long duration of treatment- dilemma for already old patient • Unscrupulous practices by Medical Practioners • False hopes and magic cures being offered

  22. Case histories –Successful candidatesCASE STUDY 1( With Consent from patients) • Mr.Bhasker & Dr.Kumudha M.D • Date of Consultation : Feb 2005 • Cause of Infertility: • Pelvic scan revealed –Polycystic ovarian disease • HSG – Block in both fallopian tubes at distal ends • Normal Semen analysis

  23. HSG -blocked

  24. Clinical discussion • Investigations performed • Semen analysis • Pelvic Scan • HSG • Counseling on • Current medical status • Rx that they have received • Risk involved with the treatment • Success rate of the treatment

  25. Result USG - Pregnancy HSG – Patent Fallopian Tubes

  26. Outcome • Effects of treatment (Medicines, Food, habits) were explained to the patient • Treatment taken for 13 months • Couple conceived in March 2006 • Dr.Kumudha being an Allopathic Doctor did not do any unnecessary investigations knowing the low success percentages.

  27. Case Study 2( With Consent from patients) • Mr.Franklin Samuel 31 yrs • Mrs. Catherine Samuel 27 yrs • Date of Consultation: December 2000 • Cause for Infertility: • Azoospermia • No significant problem in female

  28. Clinical discussion • Investigations performed • Semen analysis • Pelvic Scan • HSG • Counseling on • Current medical status • Rx that they have received • Risk involved with the treatment • Success rate of the treatment

  29. Result

  30. Outcome • Effects of treatment (Medicines, Food, habits) were explained to the patient • Treatment taken for 15 months • Mrs.Catherine Conceived on Feb 2002

  31. Invg in Mr.Franklin Testicular Biopsy Hormonal therapy Steroid administration Invg. on Mrs.Catherine Hormonal therapy Diagnostic Laproscopy Ethical issuesUnnecessary investigations performed

  32. Case histories –Successful candidatesCASE STUDY 3( With Consent from patients) • Mr. Singaravelan • Mrs. Kalaivani • Date of Consultation: 19th April 1999 • Cause for Infertility: • Bilateral Fallopian tube block • No Significant problems in Male

  33. Clinical discussion Discharge Summary –CMC Vellore • Investigations performed • Semen analysis • Pelvic Scan • HSG • Counseling on • Current medical status • Rx that they have received • Risk involved with the treatment • Success rate of the treatment

  34. Result HSG report –Blocked tubes Pregnancy Test- Positive

  35. Outcome • Effects of treatment (Medicines, Food, habits) were explained to the patient • Treatment taken for 20 months • Mrs. Kalaivani conceived on Jan 2001

  36. Case histories –Successful candidatesCASE STUDY 4( With Consent from patients) • Mr. Muthukumar • Mrs. Chitra Devi • Date of Consultation: 9th May 2001 • Cause for Infertility: • Bilateral Fallopian tube block in Female • Azoospermia in Male counterpart • Combined cause for Infertility

  37. Clinical discussion • Investigations performed • Semen analysis • Pelvic Scan • HSG • Counseling on • Current medical status • Rx that they have received • Risk involved with the treatment • Success rate of the treatment

  38. Investigations HSG report –Blocked tubes Semen Analysis- Azoospermia

  39. Result of treatment HSG report –Patent tubes Semen Analysis -Normal

  40. Effects of treatment (Medicines, Food, habits) were explained to the patient Treatment taken for 4 years Mrs. Chitradevi conceived on 10th Feb 2005 Outcome

  41. Ethical issues in this case • Couple advised • Surgery for removing Fallopian tube blocks • Donor Insemination • Expensive In-vitro fertilization techniques • But the same couple received Siddha treatment • They had a Spontaneous conception • Now they are healthy & happy

  42. Bio ethical dilemmas - 1 • A 36 yr old lady & her husband consulted for Infertility in a Major South Indian hospital • Investigations revealed Sperm count abnormality in the Husband (Azoozspermia) • Underwent Artificial Insemination with Husbands Sperms • Conceived & Delivered a Healthy boy baby • DNA testing after 1 yr revealed no Paternal links • Investigations revealed Patient Underwent DONOR Insemination without consent at Hospital • Legal opinion sought and has filed for divorce. • Future of the child ? ? ?...

  43. Bio ethical dilemmas -2 • A 32 & 30 yr old couple sought consultation for male factor infertility • They already had a child through Artificial Insemination by Donor (AID) • Father expressed a desire for a own child • Underwent Endogenous treatment for Male factor Infertility (Oligospermia) • Successful spontaneous conception • Delivered a healthy baby • Father now shuns the earlier child from AID

  44. Bio ethical dilemmas 3 • A 35 & 32 yr old couple with female factor infertility (blocked fallopian tubes) • Assured of 100% success with IVF • Sold his house to mobilize money for the IVF • Was not Successful in conception by IVF • Heart broken & homeless ! • NO HOME and NO HEIR!

  45. Bio ethical dilemmas- 4 • 44 yr old male & 42 yr old female sought consultation for male factor infertility • Received treatment for 2 years with herbal medicines • Male factor infertility resolved • But, wife had a menopause after 2 years • Husband wants to remarry …? • Should the Man pause now…?

  46. Bio ethical dilemmas- 5 • A 33 & 28 yr old couple with male factor infertility consulted a Endogenous Practitioner. • Was started on a regimen of Drugs without basic Medical Investigations (RFT) • During treatment Patient developed facial puffiness & Pedal edema • Was Diagnosed as a Case of heavy metal induced Renal failure • Patient now on regular dialysis. • No dreams of becoming a Father • Just wants to live…………!!!

  47. Solutions……. • The Indian Government is in the process of regulating ethical practice in Assisted reproductive technique by implementing a law. • Knowledge levels of patient regarding Medical treatment must improve. • Public awareness on resources available for treatment should increase. • Doctor-Patient relationship to improve with both having a fair view of the situation. • Medical practitioners to have high Ethical /Moral values • Medical practitioners should NEVER advertise in media to garner patients , should only offer Health information.

  48. Conclusion • There are Pros & Cons in both systems of Medicine • Both of them have situations that are pose Ethical dilemmas • An ideal balance taking the pros of each of the systems should be followed • Patient care of utmost importance ..! NOT THE SYSTEM OF MEDICINE

  49. “First ,Do no harm” Hippocrates

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