THE MINISTRY
OF HEALTH
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|
SOCIALIST
REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No.: 57/2015/TT-BYT
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Hanoi,
December 30th, 2015
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CIRCULAR
DETAILING A NUMBER OF ARTICLES OF DECREE No. 10/2015/ND-CP DATED
JANUARY 28, 2015 BY THE GOVERNMENT PROVIDING FOR CHILBIRTH BY IN VITRO
FERTILISATION AND CONDITIONS FOR SURROGACY FOR HUMANITARIAN REASONS
Pursuant to the Decree No. 63/2012/ND-CP
dated August 31, 2012 by the Government defining the functions, tasks,
entitlements and organizational structure of the Ministry of Health;
Pursuant to Decree No. 10/2015/ND-CP
dated January 28, 2015 by the Government on in vitro fertilization and
conditions for surrogacy for humanitarian reasons;
At the request of Director of Department of
Maternal Health and Children;
The Minister of Health
hereby promulgates the Circular detailing a number of articles of Decree No. 10/2015/ND-CP dated January 28, 2015 by the Government on in
vitro fertilization and conditions for surrogacy for humanitarian reasons.
Chapter I
GENERAL PROVISIONS
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This Circular provides for health standards for
people who adapt the in vitro fertilization service, have pregnancy or give
birth; facilities, equipment and staff of medical facilities permitted to carry
out the in-vitro fertilization technique; procedures for examination and
diagnosis of infertility; technical process of in vitro fertilization;
retention and sharing of information.
Article 2. Regulated
entities
This Circular applies to qualified medical
facilities prescribed in Decree No. 10/2015/ND-CP dated January 28, 2015 by the
Government on in vitro fertilization and conditions for surrogacy for humanitarian
reasons (hereinafter referred to as Decree No. 10/2015/ND-CP)
and relevant agencies, organizations and individuals.
Chapter II
STANDARDS FOR HEALTH OF
PEOPLE WHO ADAPT THE IN-VITRO FERTILIZATION TECHNIQUE; FACILITIES, EQUIPMENT
AND STAFF OF MEDICAL FACILITIES CARRYING OUT THE IN VITRO FERTILIZATION
Article 3. Standards for
health of people involved in in-vitro fertilization technique
1. Any person involved in
in-vitro fertilization must not have the following diseases: diseases that make
his/her health unsatisfactory for in-vitro fertilization, for having pregnancy
or giving birth; sexually transmitted diseases, HIV or group A/B infectious
diseases; hereditary diseases that may affect life and the development of the
child; mental illness or other diseases that makes him/her unable to have
awareness or direct his/her behavior.
2. Any person involved in
in-vitro fertilization technique must obtains a written conclusion by the head
of a medical facility qualified for carrying out the in-vitro fertilization certifying
that his/her health conditions is suitable for involving in in-vitro
fertilization procedures, for having pregnancy and giving birth.
Article 4. Standards for
facilities of medical facilities carrying out the in vitro fertilization
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2. There shall be separate
area for the conduct of in vitro fertilization with a minimum area of 500 m2
(including the path area) and the following rooms:
a) Room for receiving patients;
b) Consulting room for men and women;
c) Room for egg retrieval;
d) Room for retrieval of sperms;
dd) Fertilization laboratory;
e) Ultrasound room;
g) Room for testing sperm washing satisfying
standards recommended by World Health Organization.
Article 5. Standards for
medical equipment of medical facilities carrying out the in vitro fertilization
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1. CO2
incubator
02 pcs
2. Warmer
03 pcs
3. Sperm container
01 pcs
4. Centrifuge
01 pcs
5. Refrigerator
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6. Drying cabinet
01 pcs
7. Frozen embryo storage
01 pcs
8. Endo-vaginal
ultrasound machine
02 pcs
9. Inverted microscope
01 pcs
10. Stereo-zoom
microscope
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11. Laboratory cabinet
02 pcs
Article 6. Standards for
staff of medical facilities carrying out the in vitro fertilization
Any person directly carries out the in vitro
fertilization must satisfy the following requirements:
1. He/she shall obtain
qualifications in in-vitro fertilization technique (recognized qualifications
of trade in in-vitro fertilization technique, applicable to staff members
receiving training from overseas qualified establishments under similar or
higher conditions than those in Vietnam.
2. He/she shall obtain
certificates of having directly carried out at least 20 (twenty) cycles of
infertility treatment using in-vitro fertilization technique.
3. He/she shall obtain a
practice certificate according to regulations in the Law on Medical examination
and treatment.
Chapter III
INFERTILITY EXAMINATION
AND DIAGNOSIS PROCEDURES
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1. Requirements: Ask about
health conditions and conduct physical examination for both husband and wife.
2. For the wife
a) Clinical examination:
- Internal and external
examinations;
- Gynaecological examinations,
breast examinations.
b) Subclinical examination:
- Assessment of the ovarian
reserve by counting the secondary follicles or via AMH testing;
- Survey of operation of
ovary via endocrine testing, when necessary;
- Inspection of the smoothness
and the operation of the oviduct;
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- Testing for B hepatitis;
syphilis, tuberculosis, HIV (patients must be provided with information about
HIV testing before and after HIV testing according to law provisions on
HIV/AIDS prevention), Chlamydia;
- Scanning for cervical
cancer using HPV, pap test;
- Other special testing
(depending on conditions of specific patient): Cytomegalo virus,
Antiphospholipid, mammography, genetic testing.
3. For the husband
a) Semen analysis, according to guidelines of
WHO;
b) Testing:
- Testing for B hepatitis;
syphilis, tuberculosis, HIV (patients must be provided
with information about HIV testing before and after HIV testing according to
law provisions on HIV/AIDS prevention);
c) When necessary or in case of irregular signs:
- Internal examination;
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- Other additional
examinations as the case may be.
Article 8.
Examination and testing for infertility for single ladies
Single ladies shall received physical
examination and testing as prescribed in Clause 2 Article 7 of this Circular.
Chapter IV
IN-VITRO FERTILIZATION
PROCEDURES
Article 9. Consultation for
couples involved in vitro fertilization
Couples shall be provided with the following information:
1. Treatment procedures,
including clinical examinations, subclinical examinations, testings, ovarian
stimulation regimen, time for using drugs, supervision during the treatment
with drugs.
2. Expected time for
retrieving eggs and time for collecting sperms.
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4. Luteal phase,
supervision after embryo transfer.
5. Success rate of in-vitro
fertilization technique.
6. Possible accidents.
7. Treatment cost.
Article 10. Consultation
about special cases
1. For in vitro
fertilization with borrowed eggs
a) People involved in in-vitro fertilization
with borrowed eggs are usually old women, women with premature ovarian failure,
unhealthy or irregular ovary due to the heredity;
b) Besides information that must be provided for
couples specified in Article 9 of this Circular, the following additional
information shall be provided:
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- The transfer procedures:
egg receiver may take endometrium preparation drugs at the same time the egg
donor received ovarian stimulation so that the fresh embryo or the embryo made
from eggs of the donor can be transferred, and sperms of the husband shall be
totally frozen, and the egg receiver shall receive the transferred embryo right
then;
- Success rate of the
fertilization, depending on the age of the egg donor and the ability to accept
the embryo of the receiver;
- The heredity
characteristics of the child;
- Accident from egg
retrieval that the egg donors may meet.
The egg-receiver and her husband and the egg
donor shall sign a commitment.
2. For in vitro
fertilization carried out because the husband does not have sperm:
a) The procedure that the husband shall receive
a testicle aspiration or a percutaneous epididymal sperm aspiration to
determine whether there is sperm; if there is, his sperm can be used for in
vitro fertilization;
b) The information about the sperm collection
procedures with testicle aspiration or percutaneous epididymal sperm
aspiration, then the in vitro fertilization by intra-cytoplasmic sperm
injection (ICSI) shall be conducted;
c) The success rate, costs;
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dd) The use of sperm sample of the donor in case
the physician fails to collect sperms of the husband;
e) The heredity of the child in case of sperm
borrow.
3. For in vitro
fertilization with borrowed embryos: as prescribed in clause 1 of this Article.
4. For in vitro fertilization with
borrowed sperms for single ladies
Besides information that must be
provided for couples prescribed in Article 9 of this
Circular, the information about the heredity of the child shall be
provided.
Article 11. In vitro
fertilization procedure (IVF)
1. In vitro fertilization
(IVF) is a childbirth assistance technique where sperms are enable to
inseminate eggs outside the body (in vitro). Embryos from such insemination
shall be collected and frozen or transferred to uteruses.
2. Procedures:
a) Conduct physical examination and necessary
examinations for couples;
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c) Carry out the ovarian stimulation;
d) Supervise the development of follicles;
dd) Inject substances promoting the development
of follicles when suitable;
e) Retrieve egg through the vagina with the
assistance of ultrasound machines;
g) Assist the luteal phase, for fresh embryo
transfer;
h) Collect sperms of the husband and prepare the
sperms;
i) Let the sperms inseminate eggs according to
the traditional in vitro fertilization (IVF) or according to intra-cytoplasmic
sperm injection (ICSI);
k) Conduct the incubation in the CO2
incubator;
l) Inspect the insemination of eggs;
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n) Embryo transfer: using 2nd-date
embryo, 3rd-date embryo or 5th-date embryo (blastula),
depending on treatment regimen of specific facility carrying out the in vitro
fertilization;
o) Continue assisting the luteal phase, for
fresh embryo transfer;
p) Conduct a pregnancy test using bhCG serum;
q) Conduct an ultrasound scan of the vagina to
determine the development and location of the fetus.
Article 12. Procedures for
preparing sperms for in vitro fertilization procedure
1. Preparing sperms is a
technique to separate the most efficient sperms from damaged sperms and fluid
for in-vitro insemination.
2. Procedures
a) Collection of seminal fluid:
- The husband shall abstain
from sex for 3 to 7 days before the sperm collection;
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- Sperms shall be collected
from the masturbation. Hands and sex organs shall be cleansed before the
collection.
b) Sperm preparation:
- The sperm sample shall be
put in the warmer and wait until it totally lyses, record the time it totally
lyses;
- An amount of seminal
fluid shall be taken for the assessment of general indicator;
- Sperms shall be prepared
by basic techniques;
- Sperms collected after
the preparation are used for IVF or ICSI.
Article 13. Egg retrieval
for in vitro fertilization procedure (IVF)
1. Egg
retrieval is a technique where eggs are retrieved via vaginal ultrasound
and enable to inseminate sperms outside the body.
2. Procedures:
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b) The patient shall abstain from food before
egg retrieval and shall urinate before the procedure;
c) Vulva, vagina and cervix shall be cleansed
with physiological saline;
d) Feet and belly shall be covered with a
surgical towel;
dd) Needles shall be coated with egg retrieval environment
before egg retrieval;
g) Eggs shall be retrieved with the assistance of ultrasound machines;
h) The retrieved follicular fluid shall be sent
to laboratory for egg collection;
i) Needles shall be cleansed carefully.
3. Post-retrieval
supervision
a) The wife shall rest in the room for egg
retrieval after the retrieval;
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c) The wife shall be provide with guidance on
using drugs, date of embryo transfer (in case of fresh embryo transfer).
Article 14. Embryo transfer
procedures
1. Embryo transfer is a
technique where one or multiple embryos are transferred to the uterus of the
receiver to grow.
2. Procedures:
a) The embryo subject to transfer shall be
prepared on a plate, code of the embryo, names and ages of the embryo donor and
receiver and number of the dossier shall be carefully compared;
b) The receiver shall abstain from urinating to
make the bladder strain;
c) The patient shall lie in a posture for
gynaecological examination;
d) The vulva shall be cleansed;
dd) The cervix shall be opened with a speculum
and cleansed with embryo transfer environment;
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g) When the outer part of the catheter has been
threaded to the cervical canal, everything shall be prepared for sucking the
embryo into the inner part of the catheter;
h) The inner part of the catheter carrying the
embryo shall be lightly threaded to the uterus, its head shall be about 2 cm
distant from the bottom of the uterus;
i) The embryo shall be lightly pumped to the
uterus;
k) The catheter shall be lightly taken out of
the uterus;
l) The catheter shall be checked whether the
embryo has been fully pumped to the uterus;
m) The speculum shall be removed;
n) The patient shall rest at least 30 minutes
before she left the room;
o) The luteal phase assistance shall be
conducted.
Article 15.
Intra-cytoplasmic sperm injection (ICSI)
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2. Procedures:
a) Sperm samples shall be prepared for ICSI;
b) Retrieved eggs shall be stored in the warmer
before the procedure;
c) Plates shall be prepared for ICSI;
d) The microscope and tools for the procedure
shall be prepared;
dd) The egg-cell shall be separated;
e) The sperm shall be injected into the cytoplasm
of the egg;
g) The egg containing the injected sperm shall
be kept in the CO2 incubator;
h) The insemination shall be inspected.
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1. Sperm-collecting
procedure is a technique where sperms are retrieved from the epididymis or the
testicle aspiration and used for inseminating with the egg through the ICSI
technique, applicable to case where the semen does not contain a sperm or the
sperms cannot be ejaculated.
2. Procedures:
a) The patient shall be injected the analgesic
for systemic anaesthesia or partial anaesthesia;
b) The sex organ and the nearby area shall be
cleansed with physiological saline;
c) The epididymis/testicle shall be fixed;
d) The percutaneous epididymal sperm aspiration
or testicle aspiration shall be conducted;
e) The pathology specimens shall be looked for.
g) Sperms shall be prepared from the pathology
specimens or separated from the testicle tissue;
h) The patient shall be provided with guidance
on post-operation care.
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1. The cold storage of
sperm is a technique where the sperm sample is frozen and stored in a cold
storage environment. Such sperm can be defrosted for use when necessary.
2. Slow freezing:
a) An assessment of sperm quality shall be conducted
according to the standards of WHO;
b) Sperms shall be mixed with the freezing
substances;
c) The sperms shall be packed; name of the
patient, code and date of freezing must be written on the package;
d) The temperature shall be dropped;
dd) Samples shall be stored in liquid nitrogen.
Article 18.
Procedures for sperm thawing
1. Sperm thawing is a
technique where the sperms frozen and stored in the storage are defrosted and
washed for use.
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a) The vial containing the sperms shall be taken
out of the liquid nitrogen;
b) The vial shall be soaked in 37oC
water;
c) The container shall be opened and the frozen
sperms shall be taken;
d) An assessment of quality of sperms after
freezing shall be conducted;
dd) Thawed sperms shall be prepared for use.
Article 19.
Procedures for cold storage of testicle tissues
1. Cold storage of testicle
tissue is a technique where the testicle tissues are aspirated, then sperms are
found, frozen and stored in freezing environment. Such testicle
tissues can be defrosted for taking sperms for use when necessary.
2. Procedures:
a) Examinations, testing and consultation shall
be conducted in accordance with those of sperm-collecting procedures
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c) Testicle tissues shall be cut into small
pieces with specialized tweezers, the appearance of sperms shall be identified
and their movement shall be assess through inverted microscopes;
d) Seminiferous tubules shall be separated apart
for freezing process;
dd) Freezing substances shall be dropped into
separated seminiferous tubules; such seminiferous tubules shall be shaken and
put in freezing vials;
e) Such vials shall be kept in ambient
temperature, then the temperature shall be dropped according to the program;
g) The sample shall be put in liquid nitrogen
container for storage.
Article 20.
Procedures for testicle tissue thawing
1. Testicle tissue thawing is a technique where the testicle tissues
frozen and stored in the storage are defrosted for use
taking sperms.
2. Procedures:
a) The vial containing the testicle
tissue shall be taken out of the liquid nitrogen;
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c) Sperms shall be extracted from testicle
tissue;
d) An assessment of movement of sperms shall be
conducted;
dd) The collected sperms shall be kept and grown in the CO2 incubator;
e) Sperms shall be
re-assessed and used for ICSI.
Article 21.
Procedures for cold storage of eggs
1. Cold storage of eggs is
a technique where eggs are retrieved from the ovary, frozen and stored in
freezing environment. Retrieved and separated eggs shall be frozen through the
vitrification. When the receiver is ready for pregnancy, eggs shall be thawed.
2. Procedures:
a) An assessment of quality of egg shall be
made, parameter shall be fully recorded before freezing eggs. Depending on the
environment, the procedures may be adjusted from the standard procedures;
b) The environment for vitrification shall be
prepared;
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d) Liquid nitrogen containers shall be prepared;
dd) Quality of egg shall be assessed before the
freezing;
e) Technical plates
containing environment of vitrification shall be prepared;
g) Eggs shall be sucked in vitrification
environment;
i) Eggs shall be taken out of the vitrification
environment and laid on egg container, using a pipette;
k) The egg container shall be sucked;
l) The egg container shall be stored in a liquid
nitrogen container.
Article 22.
Procedures for egg thawing
1. Egg thawing is a technique where eggs frozen and stored in containers are
thawed.
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a) Thawing environment shall be prepared;
b) Name and number of the dossier, date of
retention and name of the patient written on the cryotop shall be checked;
c) The egg container that are taken out of the
liquid nitrogen shall be immediately sucked in the prepared environment plate;
d) Eggs shall be moved through prepared thawing
environments;
dd) Form of the eggs shall be assessed and used
for the next treatment technique.
Article 23.
Procedures for cold storage of embryo
1. The cold storage of embryos
is a technique where an embryo sample is
frozen and stored in a cold storage environment. When the receiver is ready for
pregnancy, the embryo shall be thawed and
transferred to the uterus. Vitrification freezing brings more advantages than
slow freezing; thus, currently, most of childbirth assistance center apply this
measure.
2. Procedures:
a) An assessment of quality of
the embryo shall be made, parameters shall
be fully recorded before freezing the embryo;
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c) Embryo containers shall be prepared;
d) Liquid nitrogen containers
shall be prepared;
dd) Embryo
shall be sucked in vitrification environment;
e) The embryo shall be laid on embryo container
and shall be sucked in liquid nitrogen;
g) Embryo containers shall be stored in the
container;
h) Records shall be completed.
Article 24. Procedures for
embryo thawing
1. Embryo thawing is a technique where embryos frozen and stored in
containers are thawed.
2. Procedures
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b) Name of patient, number of the dossier, date of retention written on the embryo
container shall be checked;
c) The embryo container shall be taken out of
nitrogen liquid;
d) The embryo shall be moved through prepared thawing environments;
dd) The thawed embryo shall be moved to growing
environment;
e) An assessment of the viability of embryos and
blastomeres shall be conducted;;
g) The embryo shall be grown in the CO2
incubator and shall be supervised until it is transferred.
Article 25. Frozen embryo
transfer (FET) procedures
1. Frozen embryo transfer
(FET) is a procedure where one or a number of frozen embryo are thawed and
transferred to the uterus of the prepared receiver.
2. Procedures
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b) The development of the uterine mucous
membrane shall be supervised;
c) When all conditions for embryo transfer is
satisfied, the plan on embryo transfer and date of transfer shall be notified
to the embryo growing laboratory;
d) The embryo shall be thawed; an assessment of
the development of the embryo and quality of the embryo before the transfer
shall be conducted;
dd) The embryo shall be transferred into the uterus;
e) The luteal phase assistance
shall be conducted;
g) A determination of bhCG after embryo transfer
shall be conducted;
h) A post-embryo transfer
ultrasound scan shall be conducted so that the development and location of the
pregnancy is determined.
Article 26. In
vitro maturation procedure (IVM)
1. In vitro maturation is a
technique where eggs are retrieved from the ovary from slightly-stimulated eggs
that are grown in growing plates and inseminate sperms through the
intra-cytoplasmic sperm injection (ICSI).
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a) The quantity of the follicles and the
development of the follicles and uterine mucous membrane shall be supervised
since the beginning of the period. FSH and/or hCG may be added during the
supervision;
b) Small follicles shall be retrieved when
possible;
c) The retrieved eggs may have grown after the
retrieval. Otherwise, the eggs shall be grown and their maturity shall be
checked.
d) Regarding mature eggs, follicular cells shall
be separated from eggs;
dd) The sperms shall be injected into the cytoplasm of the eggs;
e) The
insemination of eggs and the sperms after injection shall be inspected;
g) The embryo shall be grown;
h) The embryo shall be transferred into the
uterus;
i) A determination of bhCG after embryo transfer
shall be conducted;
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Article 27.
In vitro fertilization procedure (IVF) with borrowed eggs
1. In vitro fertilization (IVF)
with borrowed eggs is a childbirth assistance technique where
sperms inseminate eggs of the egg donor in an environment
outside the body (in vitro). Collected embryo shall be transferred to
the uterus of the receiver whose uterus mucous membrane has been prepared.
2. Procedures
a) Fresh embryos:
- The period of the egg
donor and receiver shall be adjusted;
- The ovary of the egg
donor shall be stimulated and the uterine mucous membrane of the receiver shall
be prepared;
- The
development of the follicles of the egg donor shall be supervised;
- The development of the uterine
mucous membrane of the receiver shall be supervised;
- When a follicle has grown
to a suitable age, it shall be injected a mature stimulation drug;
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- Sperms of the husband of
the egg receiver shall be retrieved, selected and washed;
- Sperms of the husband
shall be enable to inseminate eggs of the donor;
- The insemination shall be
inspected;
- The embryos shall be
assessed and selected;
- The selected embryo shall
be transfer to the uterus;
- The receiver shall be
assisted with endocrine after the transfer of embryo;
- bhCG shall be assessed
after the transfer of embryo;
- A post-transfer
ultrasound scan shall be conducted to determine the development quantity and
location of the pregnancy.
b) Unfresh embryos:
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- Eggs shall be retrieved
and IVF or ICSI using the sperms of the husband of the receiver shall be
conducted to produce embryos. All embryos shall be grown and frozen;
- Then, the uterine mucous
membrane of the receiver shall be prepared; the embryos shall be thawed and the
embryo transfer shall be conducted.
Article 28. In vitro
fertilization procedure (IVF) with borrowed sperms
1. In vitro fertilization
procedure (IVF) with borrowed sperms is a technique where sperms of the
donor are enable to inseminate eggs of the receiver. The collected embryo shall
be transferred to the uterus to develop or shall be frozen for later use.
2. Procedures
a) The ovarian stimulation and egg retrieval
shall be conducted on the receiver;
b) The ICSI shall be conducted using the sperm
of the donor that is thawed;
c) Embryos shall be produced and transferred to
the uterus of the receiver.
Article 29. Procedure for
selective reduction of embryos
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2. Procedures:
a) The best time for reduction of embryos is
when the pregnancy ages 7 to 8 weeks;
b) The patient shall be provide with information
about reasons for embryo reduction, procedures and possible accidents of embryo
reduction;
c) The patient shall be injected the analgesic
for systemic anaesthesia or partial anaesthesia, or combined with pre-medicated
anaesthesia;
d) The vulva and the vagina shall be cleansed;
dd) The patient shall be covered with the
operation towel;
e) An ultrasound scan shall be conducted so that
quantity and location of gestational sacs are re-assessed; embryos subject to
be destruction shall be carefully selected;
g) The needle shall be put exactly into the
embryo subject to destruction according to the guidance of the ultrasound scan
screen; when the needle has been put into the correct embryo, the embryo shall
be sucked.
h) The destroyed embryo shall be inspected to
ensure that the fetal heart does not beat anymore;
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k) Preventive antibiotics shall be taken;
l) Post-operation supervision shall be
conducted;
m) The patient shall take re-examination after
the selective reduction of embryos.
Chapter V
RETENTION AND SHARING OF
INFORMATION
Article 30. Retention of
information
1. Information about IVF cases shall be retained
at medical facilities carrying out the IVF for at least 02 (two) years since
the last treatment procedure finished.
2. Information about the donation and receipt of
sperms, eggs, embryos and the cases of surrogacy for humanitarian reasons shall
be retained at medical facilities for at least 20 (twenty) years since the last
treatment procedure finished.
Article 31. Sharing of
information
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2. National childbirth assistance center is
responsible for working as the contact point, cooperating with Department of
Maternal Health and Children (the Ministry of Health) in formulating a general
database about childbirth assistance for nationwide use.
3. When the database system has been formulated,
medical facilities qualified for carrying out the in-vitro fertilization
technique shall input sufficiently information to the general database system,
ensuring the sharing of information between the Ministry of Health and
qualified medical facilities; ensuring that the donation and receipt of sperms,
eggs, embryos and the surrogacy for humanitarian reasons are conducted
according to law.
Chapter VI
IMPLEMENTARY
CLAUSE
Article 32. Effect
This Circular comes into effect
from February 15, 2016
Circular No. 07/2003/TT-BYT dated
March 25, 2003 by the Minister of Health and section IV. Procedures for
in-vitro fertilization specified in Circular No. 12/2012/TT-BYT dated
July 15, 2012 by the Minister of Health are annulled by the effect of this
Circular.
Article 33. Responsibilities
Director of Department of Maternal Health and
Children; Director of Medical Service Administration, Heads of units affiliated
to the Ministry of Health; Director of the Departments of Health of
central-affiliated cities and provinces; agencies, organizations and
individuals that are relevant are responsible for implementing this Circular.
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PP. THE
MINISTER
THE DEPUTY MINISTER
Nguyen Viet Tien