1

BIOLOGY INVESTIGATORY
PROJECT
ON

INFERTILITY

SUBMITTED BY:
LOKESH KUMAR.A

ACKNOWLEDGEMENT:
 2

 I wish to express my deep gratitude and to the principal, Mr. RATHISH PILLAI
for his encouragement and for all the facilities he had provided for this project
work. I sincerely appreciate his magnanimity by taking me into his fold for which
I shall remain indebted to.
 I would like to express my sincere gratitude to my biology teachers, Mrs. Dr.
NISHA.S.PANICKER and Mrs.IDA ANNIE for this project would have not come
forth. I would like to offer my sincere thank to my classmates who helped me to
carry out this project successfully. It would be a great pleasure to mention their
valuable presence and advice I received from time to time.
 I would also like to extend my gratitude and thanks to my parents and friends who
had helped me in successful completion of the project.

INDEX:

S.no Title Pg.no

 3

1 Introduction 5
2 Causes of infertility 7
2.1 In females 7
2.2 In males 9
2.3 Combined infertility 10
2.4 Unexplained infertility 10
3 Diagnosis 11
3.1 Test for men infertility 11
3.2 Test for women infertility 13
4 Types 15
5 Treatment 16
5.1 Medical treatments 17
5.2 Intracytoplasmic sperm injection 18
5.3 Stem cell theraoy 18
6 Conclusion 19
7 Bibliography 20

OBJECTIVE:

 To study the topic Infertility.

 To get information about Infertility in humans.
 To study about causes of Infertility.
 To get information about Treatment for Infertility.
 4

INTRODUCTION:
Infertility: Inability to conceive or produce children even after 2 years of unprotected sexual
cohabitation is called infertility. In humans, infertility is the inability to become pregnant after one
year of intercourse without contraception involving a male and female partner. There are many
causes of infertility, including some that medical intervention can treat. Estimates from 1997 suggest
that worldwide about five percent of all heterosexual couples have an unresolved problem with
infertility. Many more couples, however, experience involuntary childlessness for at least one year:
estimates range from 12% to 28%. Male infertility is responsible for 20–30% of infertility cases,
 5

while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts.
In 10–20% of cases, no cause is found. The most common cause of female infertility is ovulatory
problems, which generally manifest themselves by sparse or absent menstrual periods. Male
infertility is most commonly due to deficiencies in the semen, and semen quality. Women who
are fertile experience a natural period of fertility before and during ovulation, and they are naturally
infertile for the rest of the menstrual cycle.
The reasons for this could be many–physical, congenital, diseases, drugs, immunological or even
psychological. In India, often the female is blamed for the couple being childless, but more often
than not, the problem lies in the male partner. Specialised health care units (infertility clinics, etc.)
could help in diagnosis and corrective treatment of some of these disorders and enable these couples
to have children. However, where such corrections are not possible, the couples could be assisted to
have children through certain special techniques commonly known as assisted reproductive
technologies (ART).
In vitro fertilization (IVF–fertilization outside the body in almost similar conditions as that in the
body) followed by embryo transfer (ET) is one of such methods. In this method, popularly known as
test tube baby programme, ova from the wife/donor (female) and sperms from the husband/donor
(male) are collected and are induced to form zygote under simulated conditions in the laboratory.
The zygote or early embryos (with up to 8 blastomeres) could then be transferred into the fallopian
tube (ZIFT–zygote intra fallopian transfer) and embryos with more than 8 blastomeres, into the
uterus (IUT – intra uterine transfer), to complete its further development. Embryos formed by in-
vivo fertilization (fusion of gametes within the female) also could be used for such transfer to assist
those females who cannot conceive.
Transfer of an ovum collected from a donor into the fallopian tube (GIFT – gamete intra fallopian
transfer) of another female who cannot produce one, but can provide suitable environment for
fertilization and further development is another method attempted. Intra cytoplasmic sperm injection
(ICSI) is another specialised procedure to form an embryo in the laboratory in which a sperm is
directly injected into the ovum. Infertility cases either due to inability of the male partner to
inseminate the female or due to very low sperm counts in the ejaculates, could be corrected by
artificial insemination (AI) technique. In this technique, the semen collected either from the husband
or a healthy donor is artificially introduced either into the vagina or into the uterus (IUI – intra-
uterine insemination) of the female.
Though options are many, all these techniques require extremely high precision handling by
specialised professionals and expensive instrumentation. Therefore, these facilities are presently
 6

available only in very few centre's in the country. Obviously their benefits is affordable to only a
limited number of people. Emotional, religious and social factors are also deterrents in the
adoption of these methods. Since the ultimate aim of all these procedures is to have children, in
India we have so many orphaned and destitute children, who would probably not survive till
maturity, unless taken care of. Our laws permit legal adoption and it is as yet, one of the best
methods for couples looking for parenthood.

CAUSES OF INFERTILITY:

IN FEMALES :
Female infertility is an inability to get pregnant and have a successful pregnancy. At least
10% of women deal with infertility of some kind. The chances of being infertile increases as
a woman ages. The following causes of infertility may only be found in females. For a
woman to conceive, certain things have to happen: intercourse must take place around the
time when an egg is released from her ovary; the system that produces eggs has to be
working at optimum levels; and her hormones must be balanced.

For women, problems with fertilization arise mainly from either structural problems in the
Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of
 7

the Fallopian tube due to malformations, infections such as Chlamydia and/or scar tissue. For
example, endometriosis can cause infertility with the growth of endometrial tissue in the
Fallopian tubes and/or around the ovaries. Endometriosis is usually more common in women
in their mid-twenties and older, especially when postponed childbirth has taken place.

Another major cause of infertility in women may be the inability to ovulate. Malformation of
the eggs themselves may complicate conception. Some women are infertile because their
ovaries do not mature and release eggOther factors that can affect a woman's chances of
conceiving include being overweight or underweight, or her age as female fertility declines
after the age of 30.s

Common causes of infertility of females include:

 Ovulation problems. (e.g. polycystic ovarian syndrome, PCOS, the leading reason
why women present to fertility clinics due to anovulatory infertility)
 Tubal blockage
 Pelvic inflammatory disease caused by infections like tuberculosis.
 Age-related factors.
 Uterine problems.
 Previous tubal ligation.
 Endometriosis.
 Advanced maternal age.
 8

IN MALES:

The main cause of male infertility is low semen quality. In men who have the necessary
reproductive organs to procreate, infertility can be caused by low sperm count due to
endocrine problems, drugs, radiation, or infection. There may be testicular malformations,
hormone imbalance, or blockage of the man's duct system. Although many of these can be
treated through surgery or hormonal substitutions, some may be indefinite. Infertility
associated with viable, but immotile sperm may be caused by primary ciliary dyskinesia. The
sperm must provide the zygote with DNA, centrioles, and activation factor for the embryo to
develop. A defect in any of these sperm structures may result in infertility that will not be
detected by semen analysis. Antisperm antibodies cause immune infertility.
 9

COMBINED INFERTILITY:
In some cases, both the man and woman may be infertile or sub-fertile, and the couple's
infertility arises from the combination of these conditions. In other cases, the cause is
suspected to be immunological or genetic; it may be that each partner is independently fertile
but the couple cannot conceive together without assistance.

UNEXPLAINED INFERTILITY:
In the US, up to 20% of infertile couples have unexplained infertility. In these cases
abnormalities are likely to be present but not detected by current methods. Possible problems
could be that the egg is not released at the optimum time for fertilization, that it may not enter
the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur,
transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized
that egg quality is of critical importance and women of advanced maternal age have eggs of
 10

reduced capacity for normal and successful fertilization. Also, polymorphisms in folate
pathway genes could be one reason for fertility complications in some women with
unexplained infertility.

DIAGNOSIS:

Before infertility testing, your doctor or clinic works to understand your sexual habits and
may make recommendations to improve your chances of getting pregnant. In some infertile
couples, no specific cause is found (unexplained infertility).

Infertility evaluation can be expensive, and sometimes involves uncomfortable procedures.

Some medical plans may not cover the cost of fertility treatment. Finally, there's no guarantee
— even after all the testing and counseling — that you'll get pregnant.

TESTS FOR MENS INFERTILITY:

 11

Male fertility requires that the testicles produce enough healthy sperm, and that the sperm is
ejaculated effectively into the vagina and travels to the egg. Tests for male infertility attempt
to determine whether any of these processes are impaired.

You may have a general physical exam, including examination of your genitals. Specific
fertility tests may include:

 Semen analysis: Your doctor may ask for one or more semen specimens. Semen is
generally obtained by masturbating or by interrupting intercourse and ejaculating your semen
into a clean container. A lab analyzes your semen specimen. In some cases, urine may be
tested for the presence of sperm.
 Hormone testing: You may have a blood test to determine your level of testosterone
and other male hormones.
 Genetic testing: Genetic testing may be done to determine whether there's a genetic
defect causing infertility.
 12

 Testicular biopsy: In select cases, a testicular biopsy may be performed to identify

abnormalities contributing to infertility or to retrieve sperm for assisted reproductive
techniques, such as IVF.
 Imaging: In certain situations, imaging studies such as a brain MRI, transrectal or
scrotal ultrasound, or a test of the vas deferens (vasography) may be performed.

TESTS FOR WOMEN INFERTILITY:

Fertility for women relies on the ovaries releasing healthy eggs. The reproductive tract must
allow an egg to pass into the fallopian tubes and join with sperm for fertilization. The
fertilized egg must travel to the uterus and implant in the lining. Any evaluation for infertility
should be done in a focused and costeffective way to find all relevant factors, and should
include the male as well as female partners. Tests for female infertility try to find out if any
of these processes are impaired.
 13

Specific fertility tests may include:

 Ovulation testing: A blood test measures hormone levels to determine whether you're
ovulating.
 Other hormone testing: Other hormone tests check levels of ovulator hormones, as
well as pituitary hormones that control reproductive processes.
 Hysterosalpingogram (HSG): This is an X-ray procedure to see if the fallopian tubes
are open and to if the shape of the uterine cavity is normal. A catheter is inserted into
the opening of the cervix through the vagina. A liquid containing iodine (contrast) is
injected through the catheter. The contrast fills the uterus and enters the tubes,
outlining the length of the tubes, and spills out their ends if they are open.
 Ovarian Reserve Testing: When attempting to test for a woman’s ovarian reserve,
the clinician is trying to predict whether she can produce an egg or eggs of good
quality and how well her ovaries are responding to the hormonal signals from her
brain. The most common test to evaluate ovarian reserve is a blood test for
folliclestimulating hormone (FSH) drawn on cycle day 3. In addition to the FSH level,
your physician may recommend other blood tests, such as estradiol, antimüllerian
 14

hormone (AMH), and/or inhibin-B, as well as a transvaginal ultrasound to do an

antral follicle count (the number of follicles or egg sacs seen during the early part of a
menstrual cycle).
 Imaging tests: Pelvic ultrasound looks for uterine or ovarian disease. Sometimes a
sonohysterogram , also called a saline infusion sonogram, is used to see details inside
the uterus that are not seen on a regular ultrasound.

TYPES:
Infertility can be primary or secondary.

 Primary infertility is when a couple has not conceived after trying for at least 12
months without using birth control.
 Secondary infertility is the inability to conceive a child or carry a pregnancy to full
term after previously giving birth.
 15

TREATMENT:
Treatment depends on the cause of infertility, but may include counseling, fertility
treatments, which include in vitro fertilization. According to ESHRE
recommendations, couples with an estimated live birth rate of 40% or higher per year
are encouraged to continue aiming for a spontaneous pregnancy. Treatment methods
for infertility may be grouped as medical or complementary and alternative
treatments. Some methods may be used in concert with other methods. Drugs used for
both women and men includeclomiphene citrate, human menopausal gonadotropin
(hMG), follicle stimulating hormone (FSH), human chorionic gonadotropin (hCG),
gonadotropin-releasing hormone (GnRH)analogues, aromatase inhibitors, and
metformin.
 16

MEDICAL TREATMENTS:

Medical treatment of infertility generally involves the use of fertility medication, medical
device, surgery, or a combination of the following. If the sperm are of good quality and the
mechanics of the woman's reproductive structures are good (patent fallopian tubes, no
adhesions or scarring), a course of ovulation induction maybe used. The physician or WHNP
may also suggest using a conception cap cervical cap, which the patient uses at home by
placing the sperm inside the cap and putting the conception device on the cervix, or
intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the
uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the
body .If conservative medical treatments fail to achieve a full term pregnancy, the physician
or WHNP may suggest the patient undergo in vitro fertilization (IVF). IVF and related
 17

techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART)

techniques.
ART techniques generally start with stimulating the ovaries to increase egg production. After
stimulation, the physician surgically extracts one or more eggs from the ovary, and unites
them with sperm in a laboratory setting, with the intent of producing one or more embryos.
Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's
reproductive tract, in a procedure called embryo transfer.

Other medical techniques are e.g. tuboplasty, assisted hatching, and preimplantation genetic

diagnosis.

IVF is the most commonly used ART. It has been proven useful in overcoming infertility
conditions, such as blocked or damaged tubes, endometriosis, repeated IUI failure,
unexplained infertility, poor ovarian reserve, poor or even nil sperm count.

INTRACYTOPLASMIC SPERM INJECTION:

ICSI technique is used in case of poor semen quality, low sperm count or failed fertilization
attempts during prior IVF cycles. This technique involves an injection of a single healthy
sperm directly injected into mature egg. The fertilized embryo is then transferred to womb.
 18

STEM CELL THERAPY:

Nowadays, there are several treatments (still in experimentation) related with stem cell
therapy. It is a new opportunity, not only for partners with lack of gametes, but also for
homosexuals and single people who wants to have offspring. Theoretically, with this therapy,
we can get artificial gametes in vitro. There are different studies, for both women and men.

CONCLUSION:

In these investigatory project, we have seen about what is infertility. What are the causes of
infertility in males and females. We have seen the testing of infertility in males and females,
types of infertility and the treatments for infertility. Infertility is often not seen as being a
issue outside industrialized countries. This is because of assumptions about overpopulation
problems and hyper fertility in developing countries, and a perceived need for them to
decrease population and birth rates the lack of health care and high rates of life-threatening
illness (such as HIV/AIDS) in developing countries, such as those in Africa, are supporting
reasons for the inadequate supply of fertility treatment options fertility treatments ,even
simple ones such as treatment for SCIs that cause infertility, therefore not usually made
available to individuals in these countries.
 19

BIBLIOGRAPHY:
 12th Biology NCERT
 google.com
 scribd.com
 bumrungrad.com