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Infertility: Types, Causes, Assisted Reproductive Technologies, Practice Problems and FAQs

You might have heard of infertility clinics as there are a lot of advertisements shown in television and other media related to this these days? How do these infertility clinics help couples?

infinity clinic

So what is infertility? 

Infertility is the inability of the couples to produce babies after having unprotected coitus for two years. This is quite common nowadays. 

What are the main causes of infertility? 

There are genetic and lifestyle reasons for infertility. Let’s take a deep dive into the details of infertility. 

Table of Contents

Types of Infertility

Infertility in a relationship can be caused by abnormalities in either the male or female, or both. It is mainly of three types as follows: 

Primary infertility

It occurs when there is absence of conception.

Secondary infertility

It signifies a previous pregnancy (successful or miscarriage) followed by inability to conceive.

Relative infertility

It occurs during the lactation period due to less oestrogen release and high levels of prolactin which suppresses ovulation.

Causes of Infertility

Infertility can be caused due to various reasons such as psychological disorders, congenital diseases, drugs, immunological disorders and physical problems (non-motile sperm or low sperm count). 

Male Infertility

Infertility in males can be due to the following reasons:

  • Cryptorchidism - It is a condition in which testes are unable to descend in scrotal sacs so that sperm are not produced.
  • Erectile Dysfunction or impotence - It is the inability of a person to achieve or maintain a successful erection of the penis, preventing sexual intercourse.
  • Deficiency of hormones - Deficiency of LH, FSH, androgen, prolactin or improper functioning of thyroid hormone.
  • Deletion of the Y chromosome - This leads to reduced fertility.
  • Misuses - Consumption of excessive alcohol, use of antipsychotic and antihypersensitive drugs for long duration can reduce fertility.
  • Birth defects - Vasa deferentia and vasa efferentia are absent or blocked.
  • Oligospermia - It is caused by infections such as mumps, seminal vesicle infections, and prostate infections.
  • Antisperm antibodies - It can be made by both men and women. Once it is present in the body, it will attack sperms. 

Female Infertility

Infertility in females can be due to the following reasons:

endometritis

  • Endometritis - It is the condition in which the endometrium of the uterus is inflamed.

endometriosis

  • Endometriosis - It is the expansion of endometrial tissue outside of the uterine lumen.
  • Deficiency of hormones -Deficiency of gonadotropins such as LH or FSH, imbalance of oestrogen, progesterone or prolactin and improper functioning of thyroid hormones.
  • Anovulation - It occurs when the egg is not released from the ovary. In this case the corpus luteum does not develop. 
  • Oligoovulation - There is irregular ovulation.
  • LPD - It is the lymphoproliferative disorder which leads to the defect in the luteal phase.
  • Birth defects - These include uterine and vaginal growth problems. Fallopian tube fimbriae may also not pick up secondary oocytes.
  • Chronic cervicitis - It is the inflammation of the cervix which can lead to ineffective sperm penetration.
  • Antisperm antibody - It can be made by both men and women. Once it is present in the body, it will attack sperms. 
  • Dyspareunia - It is the painful sexual intercourse experienced by a woman.
  • Increased phagocytosis - In this case the macrophages phagocytose sperms.
  • Failures - It may be the failure of fertilisation or implantation.

Assisted Reproductive Technologies

Specialised health care units (infertility clinics) may be able to assist in the diagnosis and treatment of infertility and allow the couples to become parents. Infertility treatment consists of a series of medical procedures called assisted reproductive technologies (ART).

Types of ARTs

There are two types of ARTs as follows:

  • In vivo fertilisation 
  • In vitro fertilisation

In vitro fertilisation or test tube baby programme

In this case the fertilisation takes place outside the female's body. It involves the following steps:

Superovulation 

In the beginning, hormone treatment is given to females to produce more than one egg in one cycle called as superovulation

Female Gamete Retrieval

The doctor uses a noninvasive method called transvaginal oocyte retrieval to harvest the ova after the hormone medication has helped develop many mature eggs. A tiny needle is introduced through the vaginal wall and into the ovaries for transvaginal egg retrieval, and numerous mature ova are extracted. 

transvaginal oocyte retrieval

Sperm Collection

The doctor collects sperm from the male in the form of semen, either through ejaculation or other means. Collection condoms allow the collection of sperm via intercourse to ensure sperm viability and motility. 

collection condom

If a blockage is inhibiting normal sperm ejaculation then surgical techniques can also be used.

surgical method

In vitro Fertilisation

Eggs from the wife or donor female and sperm from the husband or donor male are stimulated to form zygote in a laboratory under simulated conditions.

Embryo Transfer

It is a method in which embryos formed either by in vivo or in vitro fertilisation are implanted in the female reproductive tract for its further development. It is of two types as follows: 

ZIFT (Zygote Intra Fallopian Transfer)

It is a method in which the zygote formed after in vitro fertilisation or early embryos with upto 8 blastomeres is transferred into the fallopian tube.

zygote intra fallopian transfer

IUT (Intra Uterine Transfer)

It is a method in which embryos with more than 8 blastomeres are transferred into the uterus for further development. It is performed when an obstruction in the fallopian tubes prevents sperm from attaching to the egg normally.

intra uterine transfer

ICSI (Intracytoplasmic sperm injection) 

It is the technique of directly injecting sperm in the cytoplasm of the ovum. It is performed when the sperms have decreased motility.

intracytoplasmic sperm injection

Surrogacy

It's a situation in which a woman (the surrogate mother) agrees to bear a child for a couple, usually under the terms of a legal agreement.

In vivo fertilisation 

In this case the fertilisation takes place inside the female's body.

GIFT (Gamete Intra Fallopian Transfer)

It is a technique in which the functional ovum from a donor female is transferred to the fallopian tube of another female who cannot produce ovum but can provide the suitable environment for further development.

gamete intra fallopian transfer

Artificial Insemination (AI) 

Infertility of the male partner can occur due to very low sperm count in the semen or inability to inseminate the female.

sperm counts

The semen collected from the donor male or husband is directly injected into the vagina or uterus of the female partner in artificial insemination. This increases the chances of fertilisation by ovum by sperm.

artificial insemination

IUI (Intra Uterine Insemination)

It is the technique in which the semen collected from the donor male is directly injected into the uterus of the female partner. It is performed when vagina is too acidic or pH of semen is not alkaline enough.

Intra uterine insemination

Limitations of ART

ART has some limitations as follows:

  • Very few IVF centres are available.
  • It can be performed only by specialised professionals.
  • It requires extremely high precision handling.
  • It costs a lot of money.
  • Cannot be afforded by poor people. 
  • It creates social stigma due to ignorance. 

Practice Problems of Infertility

Question 1. Infertility cases that are caused by the male partner's inability to inseminate the female or by very low sperm counts in the ejaculates can be resolved by which ART method?

a. ICSI
b. AI
c. ZIFT
d. GIFT

Solution: Artificial insemination (AI) is the solution when infertility is caused by the male partner's inability to inseminate the female or by very low sperm counts in the ejaculates. In this procedure, the husband or donor male's sperm is directly injected into the female partner's vagina or uterus. This enhances the likelihood of ovum fertilisation by sperm. Hence, option b is correct.

Question 2. Name the technique in which puncturing of the zona pellucida layer of an egg occurs to permit artificial implantation. 

a. AI
b. Cryopreservation
c. ICSI
d. ZIFT

Solution: Intracytoplasmic sperm injection (ICSI) is a method in which a single spermatozoon or perhaps a spermatid is injected directly into the cytoplasm of the oocyte using a tiny needle. The zona pellucida layer must be pierced in order to introduce the spermatozoon directly into the ooplasm (cytoplasm of the egg) in this case. Hence, option c is correct.

Question 3. A childless couple can be assisted to have a child through a technique because the female partner cannot produce viable female gametes but can provide a suitable environment for the development of embryos. Name the technique used by doctors to help this couple.

a. ZIFT
b. IUT
c. IUI
d. GIFT

Solution: GIFT or gamete intrafallopian transfer refers to the transfer of gametes to the fallopian tubes. In this procedure, gametes (both sperm and ova) are artificially implanted into the female's fallopian tube. This is performed when a female cannot produce a functional ovum but can provide an ambient environment for the development of the foetus. Hence, option d is correct.

Question 4. Which of the following is not a cause of female infertility?

a. Y-chromosome deletions
b. Due to permanent blockage of the fallopian tube, implantation of embryo occurs here
c. Chronic inflammation of the endometrium
d. Inability of the fimbriae to transport the oocyte

Solution: Y chromosome is responsible for maleness and formation of male genitals. Thus, it cannot be the cause of female infertility. Hence, option a is correct.

FAQs of Infertility

Question 1. Under what conditions is ICSI performed?

Solution: ICSI is performed when the male partner has decreased sperm motility due to which the sperm are not able to reach the fallopian tube for fertilisation.

Question 2. Name two embryo transfer techniques performed after in vitro fertilisation?

Solution: The two embryo transfer methods followed by in vitro fertilisation are ZIFT and IUT.

For further development of the foetus, the zygote generated in vitro is put into the fallopian tube is called zygote intra fallopian transfer. An embryo having more than 8 blastomeres is transferred to the uterus is called intra uterine transfer.

Question 3. Define Assisted Reproductive Technologies.

Solution: Childless couples are assisted to have children through special techniques called assisted reproductive technology (ART).

Question 4. Write down the main causes of infertility.

Solution: Infertility can occur due to various reasons as follows:

  • Diseases and drugs 
  • Physical problems (non-motile sperm or low sperm count)
  • Congenital diseases
  • Immunological disorders
  • Psychological disorders

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