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ART Rules March, 2022-1 PDF
ART Rules March, 2022-1 PDF
[To be published in the Gazette of India, Extraordinary, Part II, Section-3, Sub section (ii)]
Government of India
Ministry of Health and Family Welfare
(Department of Health Research)
Notification
New Delhi, the March 2022
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3.2 To encourage and promote training and research in the field of assisted
reproduction.
3.3 To assist the central government in issuing guidelines, notifications and orders
pertaining to Assisted Reproductive Technology.
3.4 Any other activities as directed by central government.
4. The other powers and functions of the State/UT Boards under clause (b) of
sub-section (2) of Section 8
4.1 The State/UT Board shall, subject to provisions of this Act, rules and regulations
made there under, shall assist the National Board to develop new policies in the
area of assisted reproductive technology.
4.2 The State/UT Board shall supervise the accreditation and regulation of services
of assisted reproductive technology clinics and banks in their respective
states/UTs.
4.3 Any other activities as directed by central government.
5. Annual Report
The National /State Board shall prepare as per the prescribed format, its annual
report, giving a full account of its activities during the previous financial year, and
submit a copy to the Central / State Government.
6. Other functions of the National Registry under clause (d) of section 11
6.1 National Registry shall undertake analysis and management of the data provided
to it as per the Act. The National Registry may involve other central government
institute/s for the analysis and management of this data.
6.2 Any other activities as directed by central government/National Board.
7. Other functions of the Appropriate Authority under clause (h) of section 13.
7.1 In case required advisory committee may be constituted for addressing local
issues related to ART clinics and banks.
7.2 Any other activities as directed by the Central Government, National Board, State
Board.
8. Other powers of Appropriate Authority clause (d) of sub-section (1) of
section 14.
8.1 Appropriate Authority will have the power to question any person involved in
violation of the provisions of the Act and take necessary action as per section 14
of the Assisted Reproductive Technology (Regulation) Act, 2021.
8.2 Any other powers as delegated by the Central Government, National Board, State
Board.
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15. The conditions, form and fee for application of renewal of the registration of
clinic or bank under section 17
15.1 An application for renewal of registration shall be made in duplicate in Form 3 &
form 4, to the Appropriate Authority 60 days before the date of expiry of the
certificate of registration.
15.2 The Appropriate Authority shall, after holding an enquiry and after satisfying itself
that the applicant has complied with all the requirements of the Act and these
rules, renew the certificate of registration, as specified in Form 3 & form 4, for a
further period of five years from the date of expiry of the certificate of registration
earlier granted.
15.3 Every application for renewal of registration shall be accompanied by an
application fee of: -
Rupees 1, 00,000 for Level 1 ART Clinic
Rupees 5, 00,000 for Level 2 ART Clinic
Rupees 1, 00,000 for ART Bank
15.4 If, after enquiry and after giving an opportunity of being heard to the applicant, the
Appropriate Authority is satisfied that the applicant has not complied with the
minimum requirement of the Act and these rules, it shall, for reasons to be
recorded in writing, reject the application for renewal of certificate of registration
and communicate such rejection to the applicant as specified in Form 5 (ART
Clinic) and 6 (ART Bank), within thirty days from the date of application for
renewal.
15.5 In case of rejection, the applicant would have the right to appeal to the State
Board against the decision of the Appropriate Authority, stating clearly the
reasons for making the appeal, within 30 days of receiving the decision of the
Appropriate Authority. The State Board should take a view on the appeal within
60 days of its receipt.
15.6 On receipt of the renewal of the certificate of registration in duplicate, or on receipt
of communication of rejection of the application for renewal, both copies of the
earlier certificate of registration shall be surrendered immediately to the
Appropriate Authority by the ART clinic and/or bank.
15.7 In case of failure of renewal of the registration, the clinics and or banks would be
given time to complete the ongoing IVF procedures and continue maintenance of
embryology lab till renewal is obtained up to 90 days, however new patient
recruitment will not be allowed. If the renewal is not granted after 90 days, then
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the ART clinic and or bank would transfer all the stored gametes to another
registered ART clinic and or bank.
16 Certificate of Registration
16.1 The Appropriate Authority shall, after making such enquiry and after satisfying
itself that the applicant has complied with all the requirements, shall grant a
certificate of registration, in duplicate, in Form 7 and Form 8 to the applicant. One
copy of the certificate of registration shall be displayed by the registered ART
Clinic or ART Bank at a conspicuous place at its place of business
16.2 In case of any violation of the provisions of the Act If, after enquiry and after giving
an opportunity of being heard to the applicant the Appropriate Authority is satisfied
that the applicant has not complied with the requirements of the Act and these
rules, it shall, for the reasons to be recorded in writing, reject the application for
registration and communicate such rejection to the applicant as specified in 5 and
6.
16.3 In case of 16.2 above, the applicant would have the right to appeal to the
State Board against the decision of the Appropriate Authority, stating clearly
the reasons for making the appeal, within 30 days of receiving the decision of
the Appropriate Authority. The State Board should take a view on the appeal
within 60 days of its receipt.
16.4 The certificate of registration shall be non-transferable. In the event of change of
ownership or change of management or on ceasing to function as ART clinic or
ART bank, both copies of the certificate of registration shall be surrendered to the
Appropriate Authority.
16.5 In the event of change of ownership or change of management of the ART Clinic
or ART Bank the new owner or manager of such clinic or bank shall apply afresh
for grant of certificate of registration.
17. The manner in which an appeal may be preferred to the State Government
or the Central Government under section 19;
The format for appeal will be as specified in Form 9.
18. The criteria for availing the assisted reproductive technology procedures
under clause (a) of section 21;
The criteria for availing the assisted reproductive technology procedures will
be subject to the criteria mentioned under clause (j) of Section 2 of the
Assisted Reproductive Technology (Regulation) Act 2021.
19. The medical examination of the diseases with respect to which the
donor shall be tested under clause (b) of section 21.
Sperm/oocyte donor is tested for the following diseases:
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preservation.
28.1.3 Devise a system of storage of gametes and embryos clearly separating:
-
28.1.3.1 quarantined
28.1.3.2 unscreened
28.1.3.3 tested negative
28.1.3.4 tested positive
28.1.4 The center should have a separate storage facility of the gametes in
case of HIV, Hepatitis, HCV and other such infected patients.
28.2 The center should ensure that the storage facilities for gametes and embryos:
28.2.1 are dedicated for the purpose, and adequate for the volume and types of
activities
28.2.2 are designed to avoid proximity to ionizing radiation (radioactive
material), any known potential source of infection and
chemical/atmospheric contamination
28.2.3 have a storage-location system that minimizes the amount of handling
required to retrieve gametes and embryos.
28.3 The center should also have procedures to deal with emergency situations that
may cause damage to storage vessels, failure of storage conditions or both.
28.4 The center’s documented procedures should also ensure that:
28.4.1 gametes and embryos are stored under controlled conditions that are
validated and monitored.
28.4.2 gametes and embryos are packaged for storage in a way that prevents
any adverse effects on the material and minimizes the risk of
contamination.
28.4.3 records are kept indicating every occasion when gametes and embryos
are handled during storage and release, and by whom.
28.4.4 records are kept indicating that gametes and embryos meet
requirements for safety and quality before release.
28.5 The centers should store gametes and embryos in a designated area. Cryocans
should be fitted with local alarms and be linked to an autodial or similar facility to
alert staff to non-conformities outside normal working hours.
28.6 The center should have adequate staff and funding for an ‘on-call’ system for
responding to alarms out of working hours, and adequate spare storage capacity
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32.1.1 At least one copy each of the Act and these rules shall be available on the
premises of every ART Clinic/Bank and shall be made available to the
clientele on demand for perusal.
32.1.2 The Appropriate Authority, the Central Government, the State
Government, and the Government/Administration of the Union Territory
may publish periodically lists of registered ART Clinics/Banks and findings
from the reports and other information in their possession, for the
information of the public and for use by the experts in the field while
ensuring anonymity/ confidentiality of patients.
32.2 Meeting of the National/State Board
The Board shall meet at least once in six months and ensure that the quorum is
maintained. The meeting may be conducted virtually or physically as per the
instructions of the central government. The Board shall meet in place decided by
the administrative ministry.
33. The board may co-opt the members for its meeting after approval of the
central government for attending the proceedings of the said meeting
33.1 Any other functions/matter as directed by the Central Government.
Schedule 1 - Part 1
34. The staff requirements given below will be mandatory for all ART
Clinics/Banks.
Level 1 ART Clinic - minimum staff requirement
01 Gynecologist with qualifications as specified below
01 Counselor with qualifications as specified below
vi) Carrying out ART procedure and other ancillary procedures as the case and
facilities may warrant, based on diagnostic evidence.
vii) The ART specialist should do self-appraisal and maintain records for Audit.
35.2 Andrologist
35.2.1 The Andrologist in a clinic/ bank will be a urologist or a surgeon who has
a post-graduate degree (MS General Surgery with training in Andrology
that often takes on the task of treating male infertility along with some
experience in the field of andrology or MCH/DNB Genitourinary
surgery/Urology).
35.2.2 The additional experience includes:
35.2.2.1 training in diagnosis of various types of male infertility
covering psychogenic impotence, anatomical anomalies of
the penis which disable normal intercourse, endocrine
factors that cause poor semen characteristics and / or
impotence, infections, and causes of erectile dysfunction.
35.2.2.2 knowledge of the occupational hazards, infections and fever
that cause reversible or irreversible forms of infertility, and
knowledge of ultrasonographic and Vaso graphic studies of
the male reproductive tract. He / she must also be well-
versed in treating impotence and ejaculatory dysfunction.
35.2.2.3 he / she must understand the principles of semen analyses
and their value and limitation in diagnosis of male fertility
status. The andrologist must be able to collect semen by
prostatic massage for microbial culture in cases where
infection may lie in the upper regions (prostate, seminal
vesicles) of the reproductive tract. He / she should also be
able to collect spermatozoa through surgical sperm retrieval
techniques, and be well-versed in the technique of electro-
ejaculation. He must also be knowledgeable about the
genetic implications of using poor-quality sperm for ICSI. He
/ she should be familiar with the surgical procedures
available for correcting an anatomical defect in the
reproductive system such as epididymovasal re-
anastomosis and varicocelectomy.
35.2.2.4 an individual may act as an andrologist for more than one
clinic but each clinic where the andrologist works must own
responsibility for the andrologist and ensure that the
andrologist is able to take care of the entire work load of the
clinic without compromising on the quality of service.
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aspects of ART. The director should be able to co-ordinate the activities of the
rest of the team and ensure that staff and administrative matters, stock keeping,
finance, maintenance of patient records, statutory requirements, and public
relations are taken care of adequately. He / she should ensure that the staff are
adequately trained and are keeping up with the latest developments in their
subject, by providing them with information from the literature, making available to
them access to the latest journals, and encouraging them to participate in
conferences and meetings and present their data. The director should have a
post-graduate degree in an appropriate medical or biological science. In addition,
he / she must have a reasonable experience of ART.
Part 2
36. Requirement of Equipment and Facilities
36.1 ART Bank
36.1.1 A laboratory centrifuge
36.1.2 Laminar flow
36.1.3 Liquid nitrogen cans
36.1.4 Storage rooms and individual semen containers
36.1.5 A pharmaceutical refrigerator
36.1.6 Incubators
36.1.7 Microscope
36.1.8 Cryocans/ cryofreezers
36.1.9 Refrigerator
36.2 Level 1 ART Clinic
36.2.1 Centrifuge machine
36.2.2 Ultrasound machine
36.2.3 Laminar Air Flow
36.2.4 Binocular Microscope
36.2.5 Incubator
36.2.6 Semen wash processing facility
36.2.7 Refrigerator
36.3 Level 2 ART Clinic
36.3.1 Facility for control of temperature & humidity (Air handling unit)
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36.3.2 Filtered air with an appropriate number of air exchanges per hour
36.3.3 Wall and floors are composed of materials that can be easily washed
and Disinfected
36.3.4 A laminar flow bench with a thermostatically controlled heating plate
36.3.5 An IVF grade Stereo Microscope preferably with CCD camera and
recording software
36.3.6 A routine high powered Trinocular light microscope (IVF grade and
preferably with CCD camera and recording software)
36.3.7 A high-resolution inverted microscope with phase contrast or Hoffman
Optics (with standard IVF grade objective), preferably with facilities for
video recording
36.3.8 A micromanipulator
36.3.9 A CO2 incubator, preferably with a back up
36.3.10 A laboratory centrifuge
36.3.11 Equipment for freezing embryos
36.3.12 Liquid nitrogen cans for Screened Negative samples
36.3.13 Infected samples
36.3.14 A pharmaceutical refrigerator
36.3.15 Heating plates
36.3.16 Test tube heater
36.3.17 Heating blocks
36.3.18 Alloy blocks/ Plates
36.3.19 Biometrics (to restrict the entry)
36.3.20 Anaesthesia station and basic resusication equipment
36.3.21 VOC – Photoionisation detector
Part 3
37. Minimal Physical Requirements and Facilities for an ART Clinics and
Banks
37.1 The clinics and banks should have facilities for reception, clinical and counselling
activity, laboratory work, storage of confidential records, storing gametes and
embryos, and staff.
37.2 The clinics and banks should display a copy of its Certificate of Registration where
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37.5 A well-designed ART clinic / ART banks should have a non-sterile and a
strictly sterile area as detailed below. Some of the spaces mentioned below
could be combined (that is, the same space may be used for more than one
purpose) as long as such a step does not compromise the quality of service.
However, the space provision for the sterile area cannot be combined with that
for the non-sterile area and vice-versa.
37.5.1 Reception & Waiting area
37.5.2 Consulting Room/ Examination Room - A separate examination
room with privacy for interviewing and examining male and female
partners independently is essential. Adequate measures must be
taken to ensure that history taking and examination are carried out
in strict privacy, maintaining the dignity of the patients. In case a
male doctor examines a female patient, there must always be a
female attendant present. The room must be equipped with an
examination table and gynaecological instruments for examining
the female per vaginum, and an appropriate ultrasonographic
machine.
37.5.3 Semen Collection Room: This must be a well-appointed room with
privacy and an appropriate environment; it should be located in a
secluded area close to the laboratory. Such a facility must be available
in-house rather than having the patient collect the sample and bring it
to the laboratory for analysis as, in the latter case, semen quality and
identity is likely to be compromised. Procedures for collection of semen
as described in the WHO Semen Analysis Manual must be followed
with special reference to the type of container used; these containers
must be sterile, maintained at body temperature and nontoxic. This
room must have a washbasin with availability of soap and clean towels.
The room must also have a toilet and must not be used for any other
purpose.
37.5.4 Semen Processing Laboratory: There must be a separate room with a
laminar air flow for semen processing, preferably close to the semen
collection room. This laboratory must also have facilities for
microscopic examination of post-coital test smears. Good Laboratory
Practice (GLP) guidelines as defined internationally must be followed.
Care must be taken for the safe disposal of biological waste and other
materials (syringes, glass slides, etc.). Laboratory workers should be
immunized against hepatitis B and tetanus.
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FORM 1
License under the Assisted Reproductive Technology (Regulation) Act 2021
Address:
Under the Assisted Reproductive Technology (Regulation) Act, 2021 subject to the terms &
conditions*
Validity
Establishment Name:
Address:
Registration No.:
Date: …………………
Place: ……………….
Signature & Seal
Appropriate Authority
Terms & Conditions
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1. The License is not transferrable. The ART Clinic shall at all times be available for
inspection by the Authorities
2. The licensee shall confirm such conditions as are prescribed in rule. for this type
of facility.
3. The Licensee shall maintain proper medical record of the patients in case of birth
or death the licensee shall give intimation to the local registrar of births and
deaths.
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FORM 2
License under the Assisted Reproductive Technology (Regulation) Act 2021
Address:
Under the Assisted Reproductive Technology (Regulation) Act, 2021 subject to the terms &
conditions.
Validity
Establishment Name:
Address:
Registration No.:
Date: ……………….
Place: ……………….
Signature & Seal
Appropriate Authority
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FORM 3 (i)
Registration/ Renewal of Registration Form for Level 1 ART Clinic
E-mail: __________________________________________________________________
Website: _________________________________________________________________
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6. If yes, then please provide the Name and Address of the hospital/Institution
…………………………………………………………………………………………………
…….……………………………………………………………………………………………
1
…..…………………………………. ………………………………..
3
………………………………...… ……………………….……..
Note: If more than three, then please add separate sheets accordingly.
Qualification
Please indicate the highest qualification/degree
(1) (2) (3) (4)
Sl. Name of the Degree Area/Discipline Experience
No 1 Ph.D/DM/M.Ch. 1. Social Sciences (in yrs)
2. PG Diploma 2. Psychology
3. PG/MD/MS/DNB 3. Life Sciences
4. Diploma 4. Medicine
5. Graduate/MBBS
………………………………...… ……………………….……..
1
………………………………...… ……………………….……..
2
………………………………...… ……………………….……..
3
15. Number of paramedical staff members other than the specified above employed in
your ART Clinic (Details of conservancy/ cleaning and maintenance staff is not
required).
16. Please provide the details of the other staff members in the table given below:
(1) (2) (3) (4) (5)
Sl. Name of the Post Qualification Area/Discipline Duties
No 1. Doctorate 1. Medicine
2. Post Graduate 2. Nursing
3. Graduate 3. Life Sciences
4. Diploma 4. Social Sciences
5. Under Graduate 5. Psychology
6. Any other 6. Any other
…………………...... …………................ …………................... ………………
0 1
........………….....… ……….………..…. ………………….….. ………………
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20. Appropriate steps taken for correct identification (name of the patient) of gametes.
1. Yes 2. No
21. To avoid mixing of gametes whether proper labeling of patient’s name is being done
on
1. Yes 2. No
a) All tubes
b) Dishes
c) Pipettes
22. Whether your ART Clinic has got hormone assay facility
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1. Yes 2. Outsource
23. Whether an appropriate provision for back-up power supply available at your Clinic?
1. Yes 2. No
24. Indicate which of the following ART procedures are being routinely carried out at your
ART Clinic
1. Yes 2. No
i) Artificial Insemination with Husband Semen (AIH)
ii) Artificial Insemination with Donor Semen (AID)
iii) Intra-uterine Insemination using Husband Semen (IUI-H)
iv) Intra-uterine Insemination using Donor Semen (IUI-D)
v) Processing or storage of gametes (sperm & oocyte) of patient
vi) Any other procedure, please specify…………………………………….
DECLARATION
I hereby declare that the entries in this form and the additional particulars, if any,
furnished herewith are true to the best of my knowledge and belief.
Date: ___________
(Signature of the Director of the Level 1 ART Clinic)
Name: ……………………………………………
Designation with Seal
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FORM 3(ii)
E-mail: __________________________________________________________________
Website: _________________________________________________________________
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5. If yes, then please provide the Name and Address of the hospital/Institution
…………………………………………………………………………………………………
…….……………………………………………………………………………………………
6. Whether your hospital/Institution is having more than one ART clinics within the
country
1. Yes 2. No
9. Please give the name, address and contact details of the sub-clinics/branches which
are situated in different regions of the country under the head clinic.
…………………………………………………………………………………………………
…….……………………………………………………………………………………………
…………………………………………………………………………………………………
SECTION - II (MANPOWER)
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Qualification
Please indicate the highest qualification/degree
(1) (2) (3) (4)
Sl. Name of the Degree Area/Discipline Experience
No. 1. Ph.D./DM/M.Ch. 1. Medicine (in yrs)
2. PG/MD/MS/DNB 2. Life Sciences
3. PG Diploma 3. Any other
4. Diploma
5. Graduate/MBBS
6. Any other
1 ……………………………………….. ………………………….
1 ……………………………………….. ………………………….
2 ……………………………………….. ………………………….
3
……………………………………….. ………………………….
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Qualification
Please indicate the highest qualification/degree
(1) (2) (3) (4)
Sl. Name of the Degree Area/Discipline Experience
No. 1. Ph.D./DM/M.Ch. 1. Urology (in yrs)
2. MD/MS/DNB 2. General Surgery
3. PG Diploma 3. Any other
4. Any other
1 ………….…………………….……… …..……………………….......
2 ………….…………………….……… …..……………………….......
3 ………….…………………….……… …..……………………….......
.
Note: If more than three, then please add separate sheets accordingly.
19. If yes, then please indicate the total number of Clinical Embryologists.
1 ………………………….…………….. …......…………..………..
2 ………………………….…………….. …......…………..………..
3 ………………………….…………….. …......…………..………..
Note: If more than three, then please add separate sheets accordingly.
21. Whether your ART Clinic has Counselor
1. Yes 2. No
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1
…………………………………………. ……………………….….
2 …………………………………………. ……………………….….
.
1
…………………………………………. ……………………….….
2 …………………………………………. ……………………….….
27. Number of paramedical staff members other than the specified above employed
in your ART Clinic.
28. Please provide the details of the other staff members (details of conservancy/
cleaning/ maintenance staff is not required) in the table given below:
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35. Whether an appropriate provision for back-up power supply available at our ART
clinic?
1. Yes 2. No
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SECTION - IV (PROCEDURES)
36. Indicate which of the following ART procedures are being routinely carried out at your
ART Clinic
1. Yes 2. No
i) Artificial Insemination with Husband Semen (AIH)
ii) Artificial Insemination with Donor Semen (AID)
iii) Intra-uterine Insemination using Husband Semen (IUI-H)
iv) Intra-uterine Insemination using Donor Semen (IUI-D)
v) In vitro Fertilization-Embryo Transfer (IVF-ET)
vi) Gamete Intrafallopian Tube Transfer (GIFT)
vii) Intra-cytoplasmic Sperm Injection (ICSI)
viii) Physiological Intra-cytoplasmicSperm Injection (PICSI)
ix) Intra-cytoplasmic Morphologically Selected Sperm Injection (IMSI)
x) Round Spermatid Nucleus Injection (ROSNI)
xi) Elongated Spermatid Injection (ELSI)
xii) Percutaneous Epididymal Sperm Aspiration (PESA)
xiii) Microsurgical Epididymal Sperm Aspiration (MESA)
xiv) Testicular Sperm Aspiration (TESA)
xv) Testicular Sperm Extraction (TESE)
xvi) Processing or storage of gametes (sperm & oocyte) and or embryos
of patient
xvii) Pre-implantation Genetic Diagnosis (PGD)
xviii) Pre-implantation Genetic Screening (PGS)
xix) Endometrial Receptivity Array
xx) Time Lapse Imaging
xxi) Any other procedure, please specify……………………………………
37. Whether you have any facility for cryopreservation of patient sperm/oocyte
and or embryo
1. Yes 2. No
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DECLARATION
I hereby declare that the entries in this form and the additional particulars, if any,
furnished herewith are true to the best of my knowledge and belief.
Date: _____________
Name: ………………………………………………………….
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FORM 4
Please follow the instructions given in the Instruction Manual while filling the
proforma and use capital letters only.
________________________________________________________________________
E-mail: __________________________________________________________________
Website: ________________________________________________________________
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5. If yes, then please provide the Name and Address of the hospital/Institution
…………………………………………………………………………………………………
…….………………………………………………………………………………………….
6. Whether your Bank is having more than one ART Bank within the country
1. Yes 2. No
8. If head Branch, please specify total number of sub-branches under head branch
SECTION - II (MANPOWER)
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Qualification
Please indicate the highest qualification/degree
(1) (2) (3) (4)
Sl. Name of the Degree Area/Discipline Experience
No. 1. Ph.D./DM/M.Ch. 1. Medicine (in yrs)
2. PG/MD/MS/DNB 2. Life Sciences
3. PG Diploma 3. Hospital
4. Diploma administration
5. Graduate/MBBS 4. management
6. Any other 5. Any other
1 ………………………………………….. ..……………………….
11. Give the details of all other medical staff employed in your bank with names and
indicate the highest qualification/ degree of each staff.
(1) (2) (3) (4) (5)
Sl. Name of the degree Area/Discipline Duties/ Experience
No. 1. Ph.D./DM/M.Ch. 1. Urology Responsibilit (in yrs)
2. MD/MS/DNB 2. General Surgery y in brief
3. MBBS 3. Life Sciences
4. PG Diploma/Degree 4. Other
5. Any other
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Qualification
Please indicate the highest qualification/degree
(1) (2) (3) (4)
Sl. Name of the Degree Area/Discipline Experience
No. 1. Ph.D./DM/M.Ch. 1. Social Sciences (in yrs)
2. PG/MD/MS/DNB 2. Psychology
3. PG Diploma 3. Life Sciences
4. Diploma 4. Medicine
5. Graduate/MBBS 5. Any other
6. Any other
1
………………………………..…..……… ………………….….
2 ………………………………..…..……… ………………….….
3
………………………………..…..……… ………………….….
15. Number of paramedical staff members other than the specified above employed
in your ART Bank (Details of conservancy/cleaning staff is not to be entered)
16. Please provide the details of the other paramedical staff members in the table given
below:
(1) (2) (3) (4) (5)
Sl. No Name of the Qualification Area/Discipline Duties
Post 1. Doctorate 1. Medicine
2. Post Graduate 2. Nursing
3. Graduate 3. Life Sciences
4. Diploma 4. Social Sciences
5. Under Graduate 5. Psychology
6. Any other 6. Any other
…………………………....… ……………………………….............. ………….......................................... ………………………….…….…
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19. To avoid mixing of the samples whether proper labeling of donor name is being done on
1. Yes 2. No
i) All tubes
ii) Dishes
iii) Transfer pipettes
20. Whether an appropriate provision for back-up power supply available at your ART
Bank
1. Yes 2. No
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SECTION - IV PROCEDURES
25. Indicate which of the following procedures are being routinely carried out at your ART
Bank
1. Yes 2. No
i) Collection of Semen
a) Ejaculation
b) Electroejaculation (in case of retrograde ejaculation)
ii) Processing of Sperm
iii) Storage of Sperm
iv) Provision /sourcing of oocyte donor
26. Cryopreservation of sperm
1. Yes 2. No
DECLARATION
I hereby declare that the entries in this form and the additional particulars, if any,
furnished herewith are true to the best of my knowledge and belief.
Date: _____________
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FORM 5
No………………………………………
Date: ……………………
SEAL
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FORM 6
Date: ……………………
SEAL
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FORM 6
Certificate Of Registration
ART Clinic (Level 1/Level 2)
(To be issued in duplicate)
Certificate No.:……………………
2. This registration is granted subject to the aforesaid Act and Rules there under and
any contravention thereof shall result in suspension or cancellation of this certificate
of registration before the expiry of the said period of five years.
Place: …………………….
SEAL
Display one copy of this certificate at a conspicuous place at the place of business.
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FORM 7
Certificate of Registration
ART Bank (Semen/Oocyte/Both)
Certificate No.:…………………………
2. This registration is granted subject to the aforesaid Act and Rules there under and
any contravention thereof shall result in suspension or cancellation of this certificate
of registration before the expiry of the said period of …………years.
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FORM 7
Certificate of Registration
ART Clinic (Level 1/Level 2)
(To be issued in duplicate)
2. This registration is granted subject to the aforesaid Act and Rules there under and
any contravention thereof shall result in suspension or cancellation of this certificate
of registration before the expiry of the said period of …………...
Place: ……………………
SEAL
Display one copy of this certificate at a conspicuous place at the place of business
*Strike out whichever is not applicable or necessary
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FORM 8
Certificate of Registration
ART Bank (Semen/Oocyte/Both)
2. This registration is granted subject to the aforesaid Act and Rules there under and
any contravention thereof shall result in suspension or cancellation of this certificate
of registration before the expiry of the said period of ……….years.
Place: ……………………
SEAL
Display one copy of this certificate at a conspicuous place at the place of business.
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FORM 9
Before the Central Appellate Authority
Or the State Appellate Authority
Appeal No./20……….……
Prayer.
That the appellant, therefore prays for the reasons stated above and as may be argued at
the time of hearing, the records and proceedings be called for, this appeal be allowed, the
order under the appeal be set aside and quashed, and order deemed just and proper may
kindly be passed in favor of the appellant.
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FORM 9(i)
[Refer rule …….]
Proforma/ Affidavit before the Central Appellate Authority Orthe State Appellate
Authority
In the matter of:
Name of the Appellant (Appellant)
Versus
Concerned Appropriate Authority (Respondent)
AFFIDAVIT
37.2 That I am the Appellant in the captioned matter filed before the Appellate Authority
and aware of all the facts and circumstances of the case, hence competent to swear
this affidavit.
37.3 That the accompanying Memo of Appeal has been drafted by my counsel under my
instruction and the same has been understood by me, the same may be read as the
part and parcel of this affidavit, and the same has not been repeated here for the
sake of brevity.
Deponent
Verification
Deponent
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FORM 9 (ii)
APPENDIX No…
See RuIe ……….
Index
SYNOPSIS
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List of Documents
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FORM- 10
Instructions
The Appropriate Authority reviews all complaints and all complaints are treated in the same
manner and assessed through the same review process. All complaints are reviewed in the
order they are received. Please be aware that the review process is detailed and can be
lengthy, depending on the circumstances. The length of time required for resolution will also
vary. Once the Authority has received your complaint, you will be notified through mail.
Address line 1:
Address line 2:
I am the patient
I am representing the patient for the purposes of this complaint and I have completed the
Authorization for Representation form.
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Name:
Address line 1:
Address line 2:
Address line 1:
Address line 2:
Please describe your complaint in as much detail as possible. Be sure to include specific
information the date, time, timelines of events and location of the incident(s), staff, and
witness etc. Please enclose copies of any documents that you feel would be relevant to
your case. Note: A copy of this complaint will be sent to the Respondent you have
identified.
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Reporting Status:
Did you report this complaint to the concerned or to any other organization
Contact Details
Address:
Action taken
Complainant's Signature
Date: ………………………..
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FORM 11
Consent for Posthumous Retrieval of Sperm
Conditions:
1. The intending/commissioning couple was registered for ART procedures in a clinic
for undergoing ART and have provided prior written consent for posthumous retrieval
of sperms. The deceased male who would undergo the treatment procedure should
have received, during his life time, counselling by a counsellor providing services on
behalf of a registered provider, in relation to the prescribed matters; and
2. Consent may be withdrawn at any time before the treatment procedure or action
consented to is carried out.
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I/we have personally explained to _______________ and __________ the details and
implications of his/her/their signing this consent/approval form, and made sure to the extent
humanly possible that he/she/they understand these details and implications.
Signed: _______________________
Huband
Wife
Date: ………………….
Place: …………………
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FORM -12
Consent Form to be Signed by the Couple/Woman
1. The drugs that are used to stimulate the ovaries for ovulation induction have
temporary side- effects like nausea, headaches and abdominal bloating. Only in a
small proportion of cases, a condition called ovarian hyperstimulation occurs where
there is an exaggerated ovarian response. Such cases can be identified ahead of
time but only to a limited extent. Further, at times the ovarian response is poor or
absent in spite of using a high dose of drugs. Under these circumstances, the
treatment cycle will be cancelled.
2. There is no guarantee that:
i) The oocytes will be retrieved in all cases.
ii) The oocytes will be fertilized.
iii) Even if there were fertilization, the resulting embryos would be of suitable
quality to be transferred.
All these unforeseen situations will result in the cancellation of any treatment.
3. I/ We fully consent to these procedures and to the administration of such drugs and
anesthetics as may be necessary. We also consent to any other operative measures,
which may be found to be necessary in the course of the treatment.
4. I/ We have been told of the risks of ultrasound directed follicle aspiration.
5. I/ We are aware that we are free to withdraw or vary the terms of this consent until
the gametes and/ or embryos have been used in accordance with my/ our wishes. I
am aware that this will have to be a written request
6. There is no certainty that a pregnancy will result from these procedures even in
cases where good quality embryos are transferred.
7. If a clinical pregnancy does result from assisted conception treatment, I/ we
understand there is an accepted risk of multiple pregnancy, an ectopic pregnancy or
of a miscarriage. I/ We understand that as in natural conception, there is a small risk
of fetal abnormality.
8. Medical and scientific staff can give no assurance that any pregnancy will result in
the delivery of a normal living child.
9. The uncertainty of the outcome of the procedure has been fully explained to me/ us.
I/ We fully understand the risks of treatment including;
i) it is not possible to guarantee that a follicle will develop in a given cycle and that
occasionally cycles have to be abandoned before egg retrieval.
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ii) there is a risk that spontaneous ovulation can happen prior to/or during the egg
retreival.
iii) an egg is not always recovered from a follicle at the time of egg retrieval.
iv) any eggs may be collected and fertilization of any collected eggs will occur
v) is a risk that the cycle will be abandoned before Embryo Transfer if there is failure
of fertilization, abnormal fertilization or failure of the embryo to cleave (divide)
vi) a pregnancy may result from treatment.
vii) treatment may be abandoned at any time if there are problems in the laboratory
or with the culture system
10. I/ We have been fully informed of all that is involved with the IVF technique and have
been advised regarding the chances of success, the possibility of multiple pregnancy
occurring and other possible complications of treatment by the doctor. I/ We have
also received information relating to treatment by these techniques in order to assist
us to become more fully aware of what is involved.
This consent would hold good for all the cycles performed at the clinic.
Dated: ……………………
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FORM – 13
Consent for Intrauterine Insemination with Husband’s Semen/ Sperm
We have also been told that the outcome of pregnancy may not be the same as those of
the general pregnant population, for example in respect of abortion, multiple pregnancies,
anomalies or complications of pregnancy or delivery.
The procedure carried out does not ensure a positive result, nor does it guarantee a
mentally and physically normal child. This consent holds good for all the cycles performed
at the clinic.
_____________________(Wife)
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Dated:
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FORM – 14
Consent for Intrauterine Insemination with Donor Semen
We, __________________________________________________________________
and ____________________________________________________________, being
husband and wife and both of legal age, authorize Dr.___________________________ to
inseminate the wife artificially or intrauterine with semen / sperm of a donor (ART bank’s
no._______________________; obtained from _______________________ ART bank
with valid registration no………………………………………..…….) for achieving conception.
We have also been told that the outcome of pregnancy may not be the same as those of
the general pregnant population, for example in respect of abortion, multiple pregnancies,
anomalies or complications of pregnancy or delivery.
We declare that we shall not attempt to find out the identity of the donor.
I, the husband, also declare that should my wife bear any child or children as a result
of such insemination(s), such child or children shall be as my own and shall be my
legal heir(s).
The procedure carried out does not ensure a positive result, nor does it guarantee a
mentally and physically normal body. This consent holds good for all the cycles performed
at the clinic.
Dated: ………………
Note: An appropriate modification of this form may be used for Artificial Insemination or
Intrauterine Insemination of a single woman with donor semen.
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FORM – 15
Consent for Freezing of Embryos
*Husband
To perish
Signed: Dated:
*Wife / woman
To perish
Signed: Dated:
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Dated: ……………………………..
1. Provision of Information
As long as I have cryopreserved embryo in storage at clinic mentioned above, I
hereby agree to contact the above clinic at least annually to provide current
information indicating my address, telephone number, and intention regarding my
cryopreserved embryos.
Failure to:
(i) contact the clinic for a period of twelve months;
(ii) respond to a request for information from clinic within 90 days of receipt;
(iii) provide a new address or forwarding address where mail is returned to clinic
as undelivered,
(iv) shall constitute abandonment and signify my desire to terminate storage of
Cryopreserved embryos.
In the event of my failure to comply with (i), (ii) or (iii) above, I instruct the above-
mentioned clinic and hereby consent to the disposition of my Cryopreserved
embryos. as follows:
Cryopreserved embryos. to be removed from storage for subsequent disposal
(yes/no) ____. ____
2. Payment of Fees
I understand that I am responsible for the costs of cryopreservation and storage of
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my Cryopreserved embryos. Cryopreservation and storage fees are due and payable
at the time of gamete cryopreservation, and at the beginning of each annual storage
interval thereafter. I understand these fees are non-refundable and are not subject to
prorated adjustment for partial storage intervals. Should the yearly fee for storage of
my Cryopreserved embryos, remain unpaid for a period of one year after the first
invoice is forwarded to my address as it is listed in the clinical records at clinic can
conclude that I am no longer interested in storing these specimen(s) and I hereby
instruct the clinic to dispose of my Cryopreserved embryos.
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FORM 16
Consent for Freezing of Gametes/Sperm/Oocytes
*Husband / Man
To perish
Signed: Dated:
*Wife / Woman
To perish
Signed: Dated:
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Date: ………………
Place: ……………………
Patient’s Agreement
1. Provision of Information
As long as I have cryopreserved gametes in storage at clinic mentioned above, I
hereby agree to contact the above clinic at least annually to provide current
information indicating my address, telephone number, and intention regarding my
cryopreserved gametes. Failure to:
(i) contact the clinic for a period of twelve months;
(ii) respond to a request for information from clinic within 90 days of receipt;
(iii) provide a new address or forwarding address where mail is returned to clinic as
undelivered, shall constitute abandonment and signify my desire to terminate
storage of Cryopreserved Gametes.
In the event of my failure to comply with (i), (ii) or (iii) above, I instruct the above-
mentioned clinic and hereby consent to the disposition of my Cryopreserved
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Gametes as follows:
2. Payment of Fees
I understand that I am responsible for the costs of cryopreservation and storage of
my Cryopreserved Gametes. Cryopreservation and storage fees are due and
payable at the time of gamete cryopreservation, and at the beginning of each annual
storage interval thereafter. I understand these fees are non-refundable and are not
subject to prorated adjustment for partial storage intervals. Should the yearly fee for
storage of my Cryopreserved Gametes remain unpaid for a period of one year after
the first invoice is forwarded to my address as it is listed in the clinical records at
clinic can conclude that I am no longer interested in storing these specimen(s) and I
hereby instruct the clinic to dispose of my Cryopreserved Gametes.
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I__________________________________________________________ consent to
freezing of my …………….( sperm/oocyte). I understand that the gametes would be
normally kept frozen for ten years. In the exceptional circumstances If I/my parents/legal
guardian wish to extend this period, we would let the ART
Clinic/Bank…………………………………..(Name and address) know at least six months
ahead of time. If you do not hear from us before that time, you will be free to (a) use them
for research purposes; or (b) dispose them off. We also understand that sometimes the
quality of these ……… sperm/occytes may decrease on subsequent thaw and that frozen
gametes may have a lower pregnancy rate than when fresh gametes are used.
*Minor
Signed: Dated:
To perish
Signed: Dated:
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Date: …………………..
Place: ………………..
Terms and conditions
PARENTS’S /Legal Guardian’s
1. Provision of Information
As long as I /we have cryopreserved gametes in storage at clinic mentioned above, I /We
hereby agree to contact the above clinic at least annually to provide current information
indicating my address, telephone number, and intention regarding my cryopreserved
gametes.
Failure to:
(i) contact ………………….. (name of clinic) for a period of twelve months;
(ii) respond to a request for information from clinic within 90 days of receipt;
(iii) provide a new address or forwarding address where mail is returned to clinic as
undelivered,
shall constitute abandonment and signify my desire to terminate storage of Cryopreserved
Gametes.
In the event of my failure to comply with (i), (ii) or (iii) above, I instruct the above-mentioned
clinic and hereby consent to the disposition disposal of my Cryopreserved gametes.
2. Payment of Fees
I /We understand that I am/We are responsible for the costs of cryopreservation and
storage of my child’s Cryopreserved Gametes.
Cryopreservation and storage fees are due and payable at the time of gamete
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FORM 18
CONSENT FORM FOR WITHDRAWAL
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Dated: ………………………………
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FORM – 19
Record of use of Donor Gametes
(A separate form to be used for each individual donor) AADHAR card no. to be entered
Name of
Donor Sample Collection Supply ART Registra Receipt
person Signature
ID ID Date Date Clinic tion no. attached
Recruiting
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FORM 19 A
For Oocyte Donors AADHAR card no. to be entered
Name of Receipt
Recruitment Supply ART
Donor ID person Signature attached
Date Date Clinic
Recruiting (Yes / No)
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Form – 19 B
Oocyte-Embryo Record (AADHAR card no. to be entered)
Patient name:
ID no.:
Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Frozen Info.
Date: Date: Sci: Date: Date: Date: Date:
Time: Diss. Time: Sci.: Sci.: Sci.: Sci.: Date:
Sci.: Score Time: Time: Time: Time: Time: Time:
Dr.: Hrs.(from OPU): Hrs.: Hrs.: Hrs.: Hrs.:
Hyal. Time: Sci: Method:
Inject Time: Sci: Slow / Vitri
Fra Cell#/
Com P P Comm Straw
Egg Cell# Grade g Cell# Grade Grade FATE Grad
m. N B . no.
% e
1
10
11
12
13
14
15
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The ART bank will maintain a separate register which will give the name and address,
telephone no. etc., of the donor, that will match with the donor ID mentioned above. This
register will be kept in a safe, under lock and key, and will be accessible to only a small
number of persons in the ART bank who will be sworn on oath to maintain the above
identity secret.
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FORM - 20
Results of screening of Semen Donors / Oocyte Donors
(To include every individual screened)
A: Semen donation
B: Oocyte donation
+ Name and signature of the person certifying suitability or otherwise
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FORM - 21
Consent for Oocyte Retrieval
I have asked the Clinic named above to provide me with treatment services to help me bear
a child. I consent to:
1. Being prepared for oocyte retrieval by the administration of hormones and other
drugs
I/We consent that I/we shall be the legal parent(s) of the child and the child will have all the
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I/We have been given a suitable opportunity to take part in counselling about the
implications of the proposed treatment.
The type of anaesthetic proposed (general / regional / sedation) has been discussed in
terms which I have understood.
Dated
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FORM - 22
Consent Form for the Donor of Sperm
I understand that there will be no direct or indirect contact between the recipient, and me,
and my personal identity will not be disclosed to the recipient or to the child born through
the use of my gamete.
I understand that I shall have no rights whatsoever on the resulting offspring and vice versa.
(If applicable) My wife has agreed to the donation of my sperm. (Strike off if not applicable.)
Wife’s consent should be taken
Dated: ………………………….
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FORM –23
Consent Form for the Donor of Oocytes
I understand that there will be no direct or indirect contact between me and the recipient,
and my personal identity will not be disclosed to the recipient or to the child born through
the use of my gamete.
I understand that I shall have no rights whatsoever on the resulting offspring and vice versa.
(If applicable) My husband has agreed to the donation of my oocyte. (Strike off if not
applicable.)
I understand and accept that the drugs that are used to stimulate the ovaries to raise
oocytes have temporary side-effects like nausea, headaches and abdominal bloating. Only
in a small proportion of cases, a condition called ovarian hyperstimulation occurs where
there is an exaggerated ovarian response. Such cases can be identified ahead of time but
only to a limited extent. Further, at times the ovarian response is poor or absent in spite of
using a high dose of drugs. Under these circumstances, the treatment cycle will be
cancelled.
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Date: ………………………
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FORM 24 A
Information on Semen Donor
Basic Information
1. Identification number (Donor ID)
2. Age / Date of birth
3. Adhar No.
4. Place of birth:
5. Marital status
6. Education
i) Donor
ii) Spouse
7. Occupation
i) Donor
ii) Spouse
8. Monthly income
9. Religion
10. Address
11. Telephone
12. Email
History
13. Obstetric history of wife:
i) Number of deliveries
ii) Number of abortions
iii) Other points of note
14. History of use of contraceptives
15. Medical history
16. Family history from the medical point of view
17. History of any abnormality in a child of the donor
18. History of blood transfusion
19. History of substance abuse.
20. History of any Genetic abnormality, if available, any results of tests undertaken in
relation to that abnormality.
Investigations
21. Blood group and Rh status
22. Complete blood picture:
i) Hb
ii) Total RBC count
iii) Total WBC count
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Features
34. Height
35. Weight
36. Colour of skin
37. Colour of hair
38. Colour of eyes
Footnotes
1. To be carried out every 6 months
2. To be carried out if donor leaves within 6 months of the previous HIV test
3. Any additional test carried out on the basis of the history and examination of donor
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
All the tests should have been done within 15 days prior to the date of filling the form.
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Name and signature with date, of the person filling the form
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FORM – 24 B
Information on Oocyte Donor
Basic Information
History
13. Obstetric history
i) Number of deliveries
ii) Number of abortions
iii) Other points of note
14. Menstrual history
15. History of use of contraceptives
16. Medical history
17. Family history from the medical point of view
18. History of any abnormality in a child of the donor
19. History of blood transfusion
20. History of substance abuse
21. History of any Genetic abnormality, if available, any results of tests undertaken in
relation to that abnormality
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Investigations
22. Blood group and Rh status
23. Complete blood picture:
i) Hb
ii) Total RBC count
iii) Total WBC count
iv) Differential WBC count
v) Platelet count
vi) Peripheral smear
24. Random blood sugar
25. Blood urea / Serum creatinine
26. SGPT
27. Routine urine examination
28. HBsAg status
29. Hepatitis C status
30. HIV status with date of the tests done
31. Hemoglobin A2 (for thallasemia) status
32. Any other specific test (2)
33. Sexually transmitted diseases
Features
34. Height
35. Weight
36. Colour of skin
37. Colour of hair
38. Colour of eyes
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–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
To the patient, a copy of this form without items 16-26 filled in, may be given when asked
for. The investigations in items 16-26 may be done when the patient has chosen the donor
provisionally, subject to the results of tests in items 16-26 being satisfactory.
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