ARTs - Infertility Reasons, History, Causes in Male and Female

• Assisted Reproductive Technologies (ARTs) are specialised techniques that help infertile couples overcome infertility issues and enable them to conceive.
• Assisted Reproductive Technology (ART) does not include only IVF (In Vitro fertilization) but also several other techniques on the basis of patient's condition.
• To increase the success rate of ARTs procedures, they are paired with conventional therapies like fertility drugs.
• Almost one out of every three cycles of ARTs results in the birth of a baby.
• ART techniques are quite invasive and they are not so affordable.
• Most doctors recommend ART as a last option for conception.

Main techniques of ARTs-

1.  IVF (In Vitro fertilization) or test tube baby
2.  ICSI (IntraCytoplasmic Sperm Injection)
3.  GIFT (Gamete Intra Fallopian Transfer)
4.  AI (Artificial Insemination)

Topics covered-

• Infertility
• IVF (In Vitro fertilization)
• ICSI (IntraCytoplasmic Sperm Injection)
• GIFT (Gamete Intra Fallopian Transfer)
• AI (Artificial Insemination)

Infertility

Introduction:

• Infertility is a condition in which couples are unable to produce children in spite of unprotected sexual cohabitation for up to 1 year.
• Infertility can be found in either male or female partner or both.
• There are about 1.5 crore cases of infertility in India while in all over the world infertility cases are about 7 crores.
• Infertility can be either due to congenital or acquired causes.

Reasons for infertility:

• There are a number of causes of infertility which can be physical, congenital, disease, drugs, immunological or even physiological.
• Cause of female infertility-
  a. The most common cause is the failure of ovulation in women.
  b. Non-functional or absent uterus.
  c. Disease like gonorrheal infection causing PID, leucorrhoea, etc.
  d. Tubal infertility: Damaged or blocked fallopian tubes.
  e. Idiopathic infertility due to failure or abnormal fertilization.
  f. Malformation like adhesion of labia, imperforate hymen, etc.
  g. Vaginismus (involuntary vaginal muscle spasm) or vaginal obstruction.
   
• Cause of male infertility-
  a. Absolute impotence due to the absence of a penis.
  b. Oligospermia i.e. reduced sperm count (15-20 million per ml)
  c. Psychogenic causes like fear, anxiety or guilt of senses of sexual act, etc.
  d. Azoospermia i.e. absence or extremely low count of motile sperms.
  e. Cryptorchidism: Failure of testes to descend in the scrotal sacs.
  f. Ignorance of sexual techniques.
  g. Local diseases like hydrocoele or scrotal hernia (descending of the intestinal loop in vaginal coelom of the scrotum); phimosis (elongated prepuce); orchitis (inflammation of testicles); varicocele (abnormal enlargement of a pampiniform venous plexus in the scrotum); etc.

In Vitro fertilisation

Introduction:

• In vitro fertilisation (IVF) is a method where the fertilisation occurs outside the female body in the laboratory under aseptic conditions and is followed by the transfer of embryo in the female reproductive system for further development
• This technique is also referred to as the Test tube baby programme.
• It is one of the commonly used procedures in ARTs.
• In this technique, eggs are fertilized using the partner's or donor’s sperms, under simulated conditions in the laboratory.
• Once fertilisation has occurred Embryo Transfer (ET).
• The baby produced using IVF technique is called a test tube baby.

History:

• The first successful attempt of IVF-ET was reported in England by Dr. Patrick Steptoe and Dr. Robert Edwards.
• They experimented on Mrs Brown who had obstructed fallopian tubes.
• Their experiment succeeded and Mrs. Brown gave birth to a girl named Louis Joy Brown, who is the world’s first test-tube baby.
• Dr. Subhash Mukhopadhay was the first person who succeeded in test tube baby programme in India and the baby born was named Kanupriya Agrawal.

Procedure involved in IVF:

It involves the following steps:
1) Patient or donor female is administered with ovulation induction medication,to cause multiple ovulation.
2) With the help of laparoscopy, the multiple unfertilised ova is collected from the reproductive tract of the female.
3) The collected ova are kept under aseptic conditions to prevent infection from microorganisms.
4) After that in a culture medium, the sperm and ova are allowed to fuse, which leads to the formation of a zygote.
5) Zygote is stimulated to develop in vitro upto the 8-16 celled stage.
6) It is followed by ET.

Types of ET:

On the basis of stage and site, embryo transfer has been classified into two categories:
1. ZIFT (Zygote IntraFallopian Transfer)- In this technique, the zygote or embryo till 8-blastomere stage is transferred in the fallopian tube of the female.
2. IntraUterine Transfer (IUT)- In this technique, the embryo at more than 8 blastomere stages is transferred in the uterus of a female.

Significance of this technique:

i. It overcomes infertility issues.
ii. Men suffering from oligospermia can benefit from this technique.
iii. Embryo can be preserved for a period of about 10 years in the embryo tank for future use.
iv. This technique is a boon to infertile mothers, as ovum from a donor can also be used.
v. Embryo can also be transferred in the womb of a surrogate mother.
- Surrogate mother: The surrogate mother delivers the child for a couple who are unable to produce children.
 

ICSI (Intracytoplasmic Sperm Injection)

• ICSI stands for Intra-Cytoplasmic Sperm Injection.
• This technique basically is a method of injecting sperm directly into the ovum, in an aseptic culture medium.
• After that, the zygote is transferred to the fallopian tube or uterus of the female.
• This technique is mainly employed when the male partner suffers from conditions like oligospermia or zoospermia.

Procedure:

• Inside the egg with a microscopic needle, one of the partner's sperm is injected.
• Only one sperm is involved and is directed here whereas in IVF many sperms are allowed to fertilize the ovum naturally, in in-vitro conditions.
  
  
  

Gamete intra fallopian transfer (GIFT)-

• It refers to the transfer of an ovum collected from the ovary of donor into the fallopian tube of a female who can’t produce one, but can provide a suitable environment for fertilization.
• This technique is employed for females with sterility conditions, but having at least one functional fallopian tube and a normal uterus.
• It is an in-vivo fertilization technique, in which the fertilization is allowed inside the female body by natural coitus or artificial insemination.
• In women whose fimbriae is not capable of capturing the ovum or the ones who have a spermicidal effect because of their cervical secretions, this technique can be employed.
• In this technique, washed sperms and harvested ova are transferred to the ampulla region of the fallopian tube using a laparoscope.
• Fertilization and cleavage take place in the fallopian tube followed by implementation.
  
  
  

Artificial insemination

• Artificial insemination involves semen collection from the male partner and the introduction of the collected semen in the uterus or cervix of a female.
• This technique is useful when a male partner is suffering from conditions like oligospermia (low sperm count) or low sperm motility.

IntraUterine Insemination (IUI):

• When the collected semen is introduced into the uterus of a female then artificial insemination is said to be intrauterine insemination.

AIH:

• AIH stands for Artificial Insemination by Husband.
• In this method, the semen collected from the husband of the woman is artificially inserted into the woman’s uterus through the cervix by the help of a tube.
  
  
  

Significance of artificial insemination:

• The collected semen can be stored and used when required.
• Single semen sample can be used to fertilize many females.
• It can be employed in cases where the male is suffering from oligospermia or low sperm motility.

Frequently Asked Questions (FAQs)

Q1. Suggest ART where both male and female are having fertility issues.
Ans:
- Such couples can go for the test tube baby programme in order to have a child.
- Because this technique involves the transfer of in-vitro fertilized ovum into the uterus.

Q2. Are surrogate mothers and the gestational surrogate same?
Ans:
The gestational surrogate does not have any biological connection with the child, she carries the child which is a result of embryo transfer.
Whereas, the surrogate mother has a biological connection with the child.

Q3. What do you understand by assisted conception?
Ans:
Assisted conception refers to the pregnancy that has been conceived using assisted reproductive technologies like GIFT, IVF, etc.

Q4. What are the risks associated with Assisted Reproductive Technologies?
Ans:
Assisted reproductive technologies help infertile couples to conceive. Some of the risks associated with this technology are low birth weight, premature delivery, perinatal mortality, etc.

Q5. Which all ARTs are in vivo technologies?
Ans:
 In-vivo ART includes artificial insemination and GIFT, as in both the fertilization takes place inside a female’s body.