Chapter :4 Reproductive Health
Module : 3
INFERTILITY
&
ASSISTED REPRODUCTIVE TECHNOLOGY (ART)
INFERTILITY:
Infertility is the inability to conceive or produce children in spite of unprotected sexual cohabitation.
➢ REASONS FOR INFERTILITY IN MALES:
1. Oligospermia: The condition of low sperm count. [Normally a fertile male ejaculates 3 – 4 mL
of semen per ejaculation, which contains over 200 million motile sperms. Whereas in an
infertile male the sperm count will be low, that is only 20 million}
2. Azoospermia: It is a condition in which no sperm cells are produced or absence of live sperms.
3. Asthenozoospermia: It refers to the low sperm motility or poor motility. Sperms produced are
not actively motile and they fail to reach the ovum for fertilisation.
4. Teratozoospermia: It refers to the defects in sperm structure and form.
5. Cryptorchidism : Failure of testes to descend into the scrotum.
6. Hyperthermia : Excess or higher temperature in scrotal sac that affects the normal formation of
sperms. ( tight undergarment, mobile radiations etc)
Other reasons includes:
7. Blockage of vas deferens or sperm duct.
8. Alcoholism and drug addiction
9. Infection with mumps virus after puberty
10. Deficiency of gonadotropic hormones or male sex hormones
11. Ejaculation defects
12. Exposure to radiations.
13. Rarely genetic disease such as cystic fibrosis or any chromosomal abnormalities
➢ REASONS FOR INFERTILITY IN FEMALES:
1. Ovulation disorders like irregular ovulation, and no ovulation
2. Blockage in fallopian tubes.
3. Impaired motility of fallopian tubes.
4. Endometriosis or defective uterine endometrium. ( presence of cysts, fibroids, tumours etc)
5. Defects in cervix of uterus. ( poor cervical mucus quantity and quality)
6. Deficiency of female sex hormones.
7. Congenital anomalies (birth defects)like defective structure of uterus, defective vaginal growth etc
8. Uterine fibroids
9. Ageing
10. PCOD (Poly Cystic Ovarian Disease) or PCOS ( Poly Cystic Ovary Syndrome)
fibroids
ASSISTED REPRODUCTIVE TECHNOLOGY [ ART]
ART includes a number of special techniques which assist infertility couples to solve their
infertility problems.
ART includes the following technologies:
IVF or IVF-ET : In Vitro Fertilisation - Embryo Transfer
IUT : Intra Uterine Transfer
ZIFT : Zygote Intra-Fallopian Transfer
GIFT : Gamete Intra Fallopian Transfer
ICSI : Inta Cytoplasmic Sperm Injection
AI : Artificial Insemination
IUI : Intra Uterine Insemination
Learn Table 4.1 page:163
a) IVF – ET: (Test Tube baby)
IVF is invitro fertilization. Here fertilization occurs outside the
female body in a cultural medium, in a Petri dish under laboratorial
conditions.
In IVF , mother is administrated with drugs to induce super ovulation
(multiple eggs /oocytes are formed )
The eggs(oocytes) are collected or retrieved from the ovary of mother
by follicular aspiration and are incubated for about 4-6 hours in a
nutritive medium in a Petri dish.
Semen to be used for insemination is purified and poured over the
mature retrieved oocytes.
After about 12-24 hours the eggs are examined under microscope to see
if they have become fertilized by the sperms and are dividing into cells.
➢ The fertilized eggs are selected and incubated for about 48 to 72 hours in an
incubator. During this period fertilized eggs undergo cleavage and reach upto
32 celled stage(embryo)
➢ This embryo is then transferred to mothers uterus. (implanted on the
endometrium of uterus)
➢ The woman has now conceived and is pregnant. Further development of the
embryo continues in the womb till it is born. Such a baby is called Test tube
Baby
On the basis of embryo transfer IVF – ET is of two types:
1. IUT ( Intra Uterine Transfer) : In this technique , eggs are
retrieved from the woman, fertilized invitro and the embryo at 32
celled blastomere stage is transferred to the uterus .
2. ZIFT ( Zygote Intra-Fallopian Transfer): In this technique , eggs are
retrieved from the woman, fertilized invitro and the embryo or zygote
at 8 celled blastomere stage is transferred into the fallopian tube .
b) GIFT (Gamete Intra-Fallopian Transfer) :
In this technique selected and purified sperms and two retrieved ova
are transferred into the fallopian tube with the help of laparoscope.
This allows fertilization to take place naturally inside the mother
fallopian tube.
This technique is used in cases where husband has very low sperm
count
c) ICSI ( Intra-Cytoplasmic Sperm Injection ):
In this technique a single healthy sperm is directly injected into an ovum.
The fertilized egg is then transferred to woman's uterus as in IVF
This procedure is done in the case of low sperm count and motility.
d) AI (Artificial Insemination) or IUI ( Intra Uterine
Insemination)
In this technique the woman is artificially inseminated with her
husband's sperm or donor sperm.
The sperms are inseminated or introduced with the help of a thin
flexible catheter either into the vagina or directly into the uterus (IUI)
during the fertile period of the woman.
IUI or AI increases the chances of pregnancy manyfold.
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