What is Infertility? Explain in brief male and female infertility.

Inability of couple to conceive pregnancy after regular intercourse without contraceptive upto
one year, this is called infertility.

It a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after
12 months or more of regular unprotected sexual intercourse.

It may occur in male and female ,accordingly two types of infertility namely male infertility and
female infertility.

Male infertility:

Inability of male to cause pregnancy in a fertile female after regular intercourse without
contraceptive upto one year, this is called male infertility.

In humans it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male
infertility is commonly due to deficiencies in the semen, and semen quality.

Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a
surrogate measure of male fecundity.

Female Infertility:

Inability of female to produce offspring after regular intercourse without contraceptive upto one
year, this is called female infertility.

Infertility means not being able to get pregnant after at least one year of trying (or 6 months if
the woman is over age 35).

If a woman keeps having miscarriages, it is also called infertility. Female infertility can result
from age, physical problems, hormone problems, and lifestyle or environmental factors.

Describe the Causes of Male infertility:

Inability of male to cause pregnancy in a fertile female after regular intercourse without
contraceptive upto one year, this is called male infertility.

In humans it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male
infertility is commonly due to deficiencies in the semen, and semen quality.

There are various types of causes. They are as fallow.

Low sperm count:
Abnormal number of sperm in semen per ejaculation is called Low sperm count. It is also called
oligospermia. A healthy sperm amount is often necessary for fertility. The World Health
Organization (WHO) classifies sperm counts at or above 15 million sperm per milliliter (mL) of
semen as average. Anything below that is considered low and is diagnosed as oligospermia. Mild
oligospermia is 10 to 15 million sperm/mL. Moderate oligospermia is considered 5 to 10 million
sperm/ml. Severe oligospermia is diagnosed when sperm counts fall between 0 and 5 million
sperm/ml.The low sperm count reduces the chances of fertilization, this leads to infertility in
male.
Volume of Semen:
Semen refers to fluid which contain sperms. The normal volume of semen is 3.5 ml per ejection.
The normal volume affect on ability of sperm to successfully fertilize to ovum. Abnormal
volume of semen reduces the chances of fertilization. Hence volume of semen is very important
for fertilization
Quality of sperm:
All sperm should be mature , motile and without abnormality in head and tail. The semen should
not contain about 25% of abnormal form of sperm. If abnormal form of sperm are more than
25% that leads to cause infertility. Hence quality of sperm become essential factor in infertility.
Insufficient gonadotrophic hormones:
Gonadotrophic hormones secreted by secreted by pituitary gland called Follical stimulating
hormone (FSH) and luteinizing hormone (LH). These hormones bring about reproductive
activity in Male and Female. In male bring about spermatogenesis. If insufficient gonadotrophic
is secreted by pituitary that leads to prevent the process of spermatogenesis. This affect on
fertility in the male.
Undescended Testis:
Generally testis is present outside the abdomen, inside the Scortum where the temperature is less
than body temperature. If the testis are undescended in which spermatogenesis adversely affected
that leads to increase infertility in male.

Vericose Condition in Scortum:

A varicocele is an enlargement of the veins within the scrotum. A varicocele only occurs in
the scrotum and is very similar to varicose veins that can occur in the leg. A varicocele can result
in decreased sperm production and quality, which in some cases can lead to infertility. It can also
shrink the testicles.
Hormone imbalances:
Infertility can result from disorders of the testicles themselves or an abnormality affecting other
hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low
testosterone (male hypogonadism) and other hormonal problems have a number of possible
underlying causes.

Duct Blockage:

Duct is passage of sperm from testis to penis.It is blocked by various infections like filariasis,
gonorrhea, Tuberculosis and sometimes surgery of Harnea. This leads to blockage of duct of the
passage testis and penis. The semen produced by such a person is without sperm. This condition
causes infertility in male.

Chronic inflammatory diseases:

Chronic inflammation to the prostate and seminal vesicle may leads to cause infertility in the
male.

Explain diagnosis of infertility in male :

Infertility tests for men:

The doctor will ask the man about his medical history, medications, and sexual habits and carry
out a physical examination.
 The testicles will be checked for lumps or deformities, and the shape and structure of the
penis will be examined for abnormalities.
 Semen analysis: A sample may be taken to test for sperm concentration, motility, color,
quality, any infections, and whether any blood is present. Sperm counts can fluctuate, so
that several samples may be necessary.
 Blood test: The lab will test for levels of testosterone and other hormones.
 Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde
ejaculation.
 Chlamydia test: Chlamydia can affect fertility, but antibiotics can treat it.

Give an account of Treatment of infertility in male:

Treatment will depend on many factors, including the age of the person who wishes to conceive,
how long the infertility has lasted, personal preferences, and their general state of health .

Frequency of intercourse
The couple may be advised to have sexual intercourse more often around the time of ovulation.
Sperm can survive inside the female for up to 5 days, while an egg can be fertilized for up to 1
day after ovulation. In theory, it is possible to conceive on any of these 6 days that occur before
and during ovulation.
However, a survey has suggested that the 3 days most likely to offer a fertile window are the 2
days before ovulation plus the 1 day of ovulation.
Some suggest that the number of times a couple has intercourse should be reduced to increase
sperm supply, but this is unlikely to make a difference.

Fertility treatments for men:

Treatment will depend on the underlying cause of the infertility.

Erectile dysfunction or premature ejaculation: Medication, behavioral approaches, or both may
help improve fertility.
Varicocele: Surgically removing a varicose vein in the scrotum may help.
Blockage of the ejaculatory duct: Sperm can be extracted directly from the testicles and injected
into an egg in the laboratory.
Retrograde ejaculation: Sperm can be taken directly from the bladder and injected into an egg in
the laboratory.
Surgery for epididymal blockage: A blocked epididymis can be surgically repaired. The
epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the
epididymis is blocked, sperm may not be ejaculated properly.

Describe the causes of infertility in female

Female Infertility:

Inability of female to produce offspring after regular intercourse without contraceptive upto one
year, this is called female infertility.

Infertility means not being able to get pregnant after at least one year of trying (or 6 months if
the woman is over age 35).

If a woman keeps having miscarriages, it is also called infertility. Female infertility can result
from age, physical problems, hormone problems, and lifestyle or environmental factors.

Female infertility is caused by one or more of the factors below.

Ovulation disorders

Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in
about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the
hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.

 Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects
ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on
the face or body, and acne. It's the most common cause of female infertility.

 Hypothalamic dysfunction. Two hormones produced by the pituitary gland are

responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH)
and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low
body weight, or a recent substantial weight gain or loss can disrupt production of these
hormones and affect ovulation. Irregular or absent periods are the most common signs.

 Premature ovarian failure. Also called primary ovarian insufficiency, this disorder is
usually caused by an autoimmune response or by premature loss of eggs from your ovary
 (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it
lowers estrogen production in women under the age of 40.

 Too much prolactin. The pituitary gland may cause excess production of prolactin
(hyperprolactinemia), which reduces estrogen production and may cause infertility.
Usually related to a pituitary gland problem, this can also be caused by medications you're
taking for another disease.
Damage to fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of
the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

 Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to
chlamydia, gonorrhea or other sexually transmitted infections

 Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in
which a fertilized egg implants and develops in a fallopian tube instead of the uterus

 Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in

the United States
Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other
locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which
may block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also affect the lining of the uterus, disrupting implantation of the fertilized
egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm
or egg.

Uterine or cervical causes

Several uterine or cervical causes can impact fertility by interfering with implantation or
increasing the likelihood of a miscarriage:
  Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block
fallopian tubes or interfere with implantation, affecting fertility. However, many women
who have fibroids or polyps do become pregnant.

 Endometriosis scarring or inflammation within the uterus can disrupt implantation.

 Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause
problems becoming or remaining pregnant.

 Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or

damage to the cervix.

 Sometimes the cervix can't produce the best type of mucus to allow the sperm to travel
through the cervix into the uterus.
Unexplained infertility

Sometimes, the cause of infertility is never found. A combination of several minor factors in
both partners could cause unexplained fertility problems. Although it's frustrating to get no
specific answer, this problem may correct itself with time. But, you shouldn't delay treatment for
infertility.

Explain diagnosis of infertility in female.

If you've been unable to conceive within a reasonable period of time, seek help from your doctor
for evaluation and treatment of infertility.

Fertility tests may include:

 Ovulation testing. An at-home, over-the-counter ovulation prediction kit detects the

surge in luteinizing hormone (LH) that occurs before ovulation. A blood test for
progesterone — a hormone produced after ovulation — can also document that you're
ovulating. Other hormone levels, such as prolactin, also may be checked.

 Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee),

X-ray contrast is injected into your uterus and an X-ray is taken to detect abnormalities in
the uterine cavity. The test also determines whether the fluid passes out of the uterus and
spills out of your fallopian tubes. If abnormalities are found, you'll likely need further
evaluation. In a few women, the test itself can improve fertility, possibly by flushing out
and opening the fallopian tubes.
  Ovarian reserve testing. This testing helps determine the quality and quantity of eggs
available for ovulation. Women at risk of a depleted egg supply — including women older
than 35 — may have this series of blood and imaging tests.

 Other hormone testing. Other hormone tests check levels of ovulatory hormones as well
as thyroid and pituitary hormones that control reproductive processes.

 Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a
sonohysterogram, also called a saline infusion sonogram, is used to see details inside the
uterus that can't be seen on a regular ultrasound.

Depending on your situation, rarely your testing may include:

 Other imaging tests. Depending on your symptoms, your doctor may request a
hysteroscopy to look for uterine or fallopian tube disease.

 Laparoscopy. This minimally invasive surgery involves making a small incision beneath
your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and
uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of
the fallopian tubes, and problems with the ovaries and uterus.

 Genetic testing. Genetic testing helps determine whether there's a genetic defect causing
infertility.
Give an account of Treatment of infertility in female.

Infertility treatment depends on the cause, your age, how long you've been infertile and personal
preferences. Because infertility is a complex disorder, treatment involves significant financial,
physical, psychological and time commitments.

Although some women need just one or two therapies to restore fertility, it's possible that several
different types of treatment may be needed.

Treatments can either attempt to restore fertility through medication or surgery, or help you get
pregnant with sophisticated techniques.

Fertility restoration: Stimulating ovulation with fertility drugs

Fertility drugs regulate or stimulate ovulation. Fertility drugs are the main treatment for women
who are infertile due to ovulation disorders.
Fertility drugs generally work like the natural hormones — follicle-stimulating hormone (FSH)
and luteinizing hormone (LH) — to trigger ovulation. They're also used in women who ovulate
to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may include:

 Clomiphene citrate. Clomiphene citrate is taken by mouth and stimulates ovulation by

causing the pituitary gland to release more FSH and LH, which stimulate the growth of an
ovarian follicle containing an egg.

 Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these
injected treatments stimulate the ovary directly to produce multiple eggs. Gonadotropin
medications include human menopausal gonadotropin or hMG (Menopur)
and FSH (Gonal-F, Follistim AQ, Bravelle). Another gonadotropin, human chorionic
gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and trigger their release at the
time of ovulation. Concerns exist that there's a higher risk of conceiving multiples and
having a premature delivery with gonadotropin use.

 Metformin. Metformin is used when insulin resistance is a known or suspected cause of

infertility, usually in women with a diagnosis of PCOS. Metformin helps improve insulin
resistance, which can improve the likelihood of ovulation.

 Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase inhibitors

and works in a similar fashion to clomiphene. Letrozole may induce ovulation. However,
the effect this medication has on early pregnancy isn't yet known, so it isn't used for
ovulation induction as frequently as others.

 Bromocriptine. Bromocriptine (Cycloset), a dopamine agonist, may be used when

ovulation problems are caused by excess production of prolactin (hyperprolactinemia) by
the pituitary gland.

What are Assisted Reproductive Technology? Give an account Types of Assisted

reproductive technology (ART)
Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments
that handle both a woman's egg and a man's sperm. It works by removing eggs from a woman's
body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in
the woman's body. In vitro fertilization (IVF) is the most common and effective type of Assisted
reproductive technology.
Assisted reproductive technology procedures sometimes use donor eggs, donor sperm, or
previously frozen embryos. It may also involve a surrogate or gestational carrier. A surrogate is a
woman who becomes pregnant with sperm from the male partner of the couple. A gestational
carrier becomes pregnant with an egg from the female partner and the sperm from the male
partner.
The most common complication of ART is a multiple pregnancy. It can be prevented or
minimized by limiting the number of embryos that are put into the woman's body.
Types of assisted reproductive technologies
 Ovulation induction (OI) ...
 Artificial insemination (AI)
 Donor conception
In-vitro fertilisation (IVF)
 Gamete intrafallopian transfer (GIFT)
 Intracytoplasmic sperm injection (ICSI) .
 Preimplantation genetic testing (PGT).
 Zygote Intrafallopian transfer.
 Intrauterian Insemination (IUI)
 Surrogacy.

Give an account of In Vitro fertilization

It is a modern invention for infertile couples to obtain baby. A technique in which fertilization
brings about outside the body and inside the test tube hence it is also called test tube baby. It was
first devised by British Scientist Dr. Patrick Steptoe and Dr. Robert Edward in 1976. The first
test tube bay was born 1978 and her name is Louise Brawn.

Procedure:

In this technique first woman is medically examined if she is all right.

Then she injected fertility drug to stimulate ovary for the production of eggs.

Growth of follicles was monitored by doctor.

Once ovarian follicles are matured the woman will inject with human chorionic gonadotropin.
Then eggs are harvested by intravaginal needle without surgical incision.

The man donating sperm is also medically examined if he is all right then collects semen.

Egg and sperm are collected and allowed for fertilization Petri dish which contain special
nutrient.

Embryo(s) then placed in female’s uterus with the help of laparoscope.

The embryo implanted in the wall of uterus naturally and allowed for growth and development
upto 365 days.
Give an account of Gamete Intrafallopian Transfer (GIFT)

It is a modern invention for infertile couple to achieve pregnancy. A technique in which sperm
and ovum are transferred in fallopian tube hence it is called gamete intrafallopian transfer. It
allows fertilization to take place inside the woman's uterus it was first devised by Ricardo Asch
in 1980. The first gift baby was born in 1986 and her name is Toad Holder. The second gift baby
was born in US in 1986 and her name is Kaitlynne Kelley.

Procedure:

First woman is medically examined if she is all right.

Then she injected fertility drug to stimulate ovary for the production of eggs.

Growth of follicles was monitored by doctor.

Once ovarian follicles are matured the woman will inject with human chorionic gonadotropin.
Then eggs are harvested by intravaginal needle without surgical incision.

After three hours of collection of egg, semen sample from her husband is obtained.

Sperm then washed and prepared for loading into same catheter into which eggs will placed.
Gametes are mixed, and then injected into the woman’s fallopian tubes.

The mixture of sperm and eggs are immediately injected into the woman’s fallopian tubes so
fertilization takes place inside the woman.

This procedure can be performed surgically either through laparoscopy or small one inch
incision in the lower abdomen under general anesthesia.

Intracytoplasmic sperm injection (ICSI)

It was discovery by Patrick Steptoe, M.D. and Robert Edwards of In Vitro Fertilization (IVF),
resulting in the birth of Louise Brown.

Fertilization rates with ICSI range from 50 to 80 percent. However, not all fertilized eggs
develop into healthy embryos. Couples that use ICSI with IVF have about a 30 to 35 percent
chance for twins and a 5 to 10 percent chance for having triplets or more.

Intracytoplasmic sperm injection is beneficial in the case of male factor infertility where sperm
counts are very low or failed fertilization occurred with previous IVF attempt(s).
In the ICSI process, a tiny needle, called a micropipette, is used to inject a single sperm into the
center of the egg.

Once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to
5 days before it is transferred to the woman's uterus (womb).

Give an account of Zygote Intrafallopian transfer (ZIFT)

Zygote Intrafallopian transfer (ZIFT) is an infertility treatment used when a blockage in

the fallopian tubes prevents the normal binding of sperm to the egg.

Egg cells are removed from a woman's ovaries, and in vitro fertilised.

The resulting zygote is placed into the fallopian tube by the use of laparoscopy.

The procedure is a spin-off of the gamete intrafallopian transfer (GIFT) procedure.

Success rate of ZIFT is 64.8% in all cases.

Procedure:

The average Zygote Intrafallopian transfer cycle takes five weeks to six weeks to complete. First,
the female must take a fertility medication clomiphene to stimulate egg production in the ovaries.

The doctor will monitor the growth of the ovarian follicles, and once they are mature, the
woman will receive an injection containing human chorionic gonadotropin (HCG or chg.).

The eggs will be harvested approximately 36 hours later, usually by transvaginal ovum retrieval.
After fertilization in the laboratory, the resulting early embryos or zygotes are placed into the
woman's fallopian tubes using a laparoscope.

Give an account of Intrauterine Insemination.

The first successful experiment with artificial insemination in animals was performed by Italian
physiologist Lazzaro Spallanzani, who in 1780, while investigating animal reproduction,
developed a technique for artificial insemination in dogs

Intrauterine insemination, is a relatively simple fertility treatment. It may be done with or

without fertility drugs. The procedure itself involves transferring specially washed semen
directly into the uterus via a thin catheter. You may know of IUI by the more commonly used
term artificial insemination (AI).
The first recorded experiment with artificial insemination in humans occurred in the late 1700s,
when Scottish-born surgeon John Hunter impregnated a women with her husband’s sperm,
resulting in a successful pregnancy. In 1884 American physician William Pancoast performed a
modified artificial insemination procedure when he injected sperm from a donor into a woman
who was under anesthesia. The woman, who was married, gave birth to a baby nine months later
and did not know that she had been impregnated with donor sperm. Her husband, whom
Pancoast determined was infertile, later found out about the procedure from Pancoast.
Today artificial insemination in humans is considered a form of assisted reproductive
technology. Women impregnated in this way are physically capable of conceiving and bearing
children, though they are unable to conceive through sexual intercourse, usually because their
husband is sterile or impotent. Fresh semen is obtained from the husband (if he is impotent) or
from some other male donor (if the husband is sterile) and is introduced by a syringe into the
woman’s vagina or cervix during the middle of her menstrual cycle. The semen can also have
been previously frozen and stored in a sperm bank. The technique is reasonably successful in
achieving conception and pregnancy.