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

You might have seen lots of advertisements related to IVF clinics. Have you ever seen an IVF clinic on the way to your home or college? Did it bother you ever what it is all about? There are a large number of couples around us who are unable to produce children even after unprotected sexual intercourse for two years. Such couples are called infertile. This infertility in couples could be because of many reasons like physical, genetic, etc. The problem could be in one partner or both in this case.

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Fig: Infertility clinic

These infertility clinics provide treatment for infertility in couples. They have ways to diagnose the problem and provide them with the corrective measures to treat the disorder. So we can say these clinics are specialised health care units that provide such couples with a solution to have a child. Sometimes, these measures are not enough, in such cases, the couples are assisted with certain specialised techniques to overcome their reproductive issues. These are called assisted reproductive technologies (ART). One of the techniques which comes under this technology is ICSI. It is also known as intracytoplasmic sperm injection. This technique is most commonly used when the problem lies in the male partner. In this article let’s take a deep dive into the details of ICSI.

Table of contents

Infertility
Assisted reproductive technology
Male infertility
Intracytoplasmic sperm injection (ICSI)
Advantages of ICSI
Disadvantages of ICSI
Practice Problems
FAQs

Infertility

In order to conceive and have a child the male gamete or sperm should meet the female gamete or ovum (secondary oocyte) and fuse to form a zygote. For this purpose millions of human sperms on ejaculation reach the female reproductive system. There the sperm swims towards the fallopian tube and penetrates the egg layers and fertilises the egg.

But sometimes the sperm is not able to fertilise the egg. Thereby, leading to the problem of infertility. Infertility is the inability to conceive or produce child even after two years of unprotected sexual intercourse. This problem could be due to a disease such as an STI (sexually transmitted infections) that could cause defects in the quality of gametes or certain drugs. It could be a physical, congenital, immunological or even a psychological problem with the couple. In India, often the female is blamed for the couple being childless, but more often than not, the problem lies in the male partner.

Fig: Reasons for infertility

Assisted reproductive technology (ART)

Specialised health care units like infertility clinics could help in diagnosis and corrective treatment of some of the disorders related to infertility and enable the 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). ART is a lab based fertility treatment. In many cases, it has been noticed that the problem lies in the male partner which could be due to a number of reasons.

Male infertility

When a man is not able to make his healthy female partner pregnant after having two years of unprotected sexual intercourse is called male infertility. There could be a number of reasons that make the male sperm unable to fertilise the egg or ovum in females. These are as follows:

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

Male infertility can result due to inefficiency of LH (luteinizing hormone), FSH (follicle stimulating hormone), 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

In cases where the accessory ducts in male like the vasa deferentia and vasa efferentia are absent or blocked.

Oligospermia

The people suffering from this condition have very low sperm count with poor sperm quality. 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 sperm.

Intracytoplasmic sperm injection (ICSI) - Treatment for male infertility

Intracytoplasmic sperm Injection in short is called ICSI. It is a technique where the sperm head is injected in the cytoplasm of the egg leading to fertilisation. It is a specialised form of in vitro fertilisation that could be the solution to male infertility problems. It can provide solutions to couples with infertility and a hope to have a child.

The technique of intracytoplasmic sperm injection (ICSI)

The ICSI procedure involves insertion of sperm head in the cytoplasm of egg for fertilisation. For this the below mentioned steps are followed:

Stimulation of ovary

In this step the female will take fertility drugs to trigger the ovulation process. It is called superovulation and in this method drugs are used to allow multiple ovulation per menstrual cycle. The female needs to visit the clinic every two - three days for ultrasounds and blood tests. The doctor will also monitor the development of follicles.

Fig: Stimulation of ovary

Superovulation

The stimulated ovaries produce multiple eggs at once. Along with this human chorionic gonadotropin (hCG) hormone via injection is also given that will assist in final maturation of eggs.

Fig : Superovulation

Gathering the eggs

On maturation of ovarian follicles, patients are given a minor dose of hCG (human chorionic gonadotropin) hormone, which further escalates progesterone production for the maintenance of pregnancy. Within 36 hours normally the eggs (secondary oocytes) get harvested. Doctor gives anaesthetic and through the vaginal region inserts an ultrasound probe to look at ovaries and identify the healthy follicles. Then the eggs are removed from the healthy follicles using a thin needle inserted through the wall of the vagina. A suction device is attached with the needle that collects the eggs. Eight to fifteen eggs are normally retrieved like this. These eggs are incubated in precise conditions.

Fig : Transvaginal oocyte retrieval

Sperm collection

Sperm from male is also simultaneously collected. The physician obtains sperm from the male in the form of semen. The following methods are used for the collection of sperms.

Collection condom

It allows the sperm to be collected via intercourse to ensure sperm viability and motility.

Surgical method

In case of an obstruction preventing the normal ejaculation of sperm, this method is used.

Fig : Extraction of sperm

Collected semen is then sent to semen analysis for volume, mobility and quality. Sperm samples are stored for later use in a sperm bank by the lab. The semen is centrifuged to separate live sperm from other debris and dead sperms. The desired live sperms are picked in a glass needle.

Injecting the sperm

In this method using a pipette (glass tube with suction) holds the matured egg and the needle with sperm is injected directly into the egg’s cytoplasm. Thereby, completing the process.

Fig : Intracytoplasmic sperm injection

Implantation

After the above process, the fertilised egg is monitored for signs of successful fertilisation. It undergoes cleavage and forms the blastocyst within 5 - 6 days. Later the embryo is transferred in the female reproductive tract using a catheter via vagina. The blastocyst gets implanted on the uterus.

Fig: Implantation

Testing for pregnancy

A pregnancy test is taken about two weeks after the surgery.

Fig: Pregnancy test

Advantages of ICSI

The following are the major advantages of ICSI:

This method is useful when he male partner produces a few sperm to perform artificial insemination (AI) or IVF.
It is useful when the mobility of sperm is low.
This method can be used when the sperm is not able to penetrate outer layers of the egg.
It is used when there is a blockage in the male reproductive tract.
This method is used in cases where the eggs are not fertilised by IVF.
It is used when previously frozen eggs are used for fertilisation.
This method enhances the fertilisation rate which is about 80 to 85 percent.
This method is useful in couples struggling with male infertility.

Disadvantages of ICSI

The following are the major disadvantages of ICSI:

In some cases the eggs may get damaged by the process.
In certain cases fertilised eggs may not develop into an embryo.
In certain cases the embryo may stop development in the middle.
There is a risk of birth defects which is slightly more with ICSI treatment.
The common birth defects include Angelman syndrome (delayed growth, mental and intellectual abilities), Beckwith-Wiedemann syndrome (overgrowth syndrome), sex chromosome abnormalities, and hypospadias (the opening of the urethra will not be located at the tip of the penis in boys).
There is a risk of a male offspring with fertility issues.

Practice Problems

1. Which of the following statements is correct with respect to infertility in couples?

The couple is unable to produce children in spite of unprotected sexual intersourse
It is the ability to produce children despite of abnormalities in the female reproductive system
Infertility can result due to physical, congenital, immunological or psychological disorders only in females
It cannot be helped using assisted reproductive technology

Solution: Infertility is the inability to produce offspring in spite of unprotected sexual cohabitation (the state of living together and having a sexual relationship). It can be caused due to physical, congenital, immunological or psychological disorders in either male or female partners or both. But unfortunately, in India, often the females are blamed for the couple being childless. Several methods are available called assisted reproductive technologies (ART) to help interfile couples to successfully conceive. Hence the correct option is a.

2. Sperm head is transferred to the female egg in which of the following techniques?

ET
IVF followed by ET
GIFT
ICSI

Solution: In intra cytoplasmic sperm injection or ICSI, a tiny needle is used to inject sperm into the egg of a female. This helps individuals with extremely low sperm count in conception and also provides an alternative of using donor sperm. Hence the correct option is d.

Fig : Intracytoplasmic sperm injection

3. In which of the following cases ICSI is followed ?

Sperm is unable to penetrate outer layers of egg
Sperm count is very less
Blockage in male reproductive system
All of the above

Solution: ICSI (intra cytoplasmic sperm injection) is an assisted reproductive technology in which sperm is directly injected into the ovum in a laboratory. There could be a number of reasons for the male sperm being unable to fertilise the egg or ovum in females. In the below mentioned case ICSI is followed:

Sperm is not able to penetrate the outer layers of egg
Egg’s outer layer may be thick or hard which makes it difficult for sperm to penetrate.
Sperm have low mobility and are unable to reach the egg.
Sperm count is very low.
The male partner is unable to ejaculate.
There is blockage in the male reproductive system.
Poor sperm quality
High concentration of misshapen sperm.

Hence the correct option is d.

4. Which hormones help in maturation of eggs?

hCG
Melanin
Vasopressin
Adrenalin

Solution: In case of ICSI, instead of one egg, the female body is made to release many eggs to increase the chances of fertilisation by superovulation. The stimulated ovaries produce multiple eggs at once. Along with this human chorionic gonadotropin (hCG) hormone via injection is also given that will assist in final maturation of eggs. Hence the correct option is a.

FAQs

1. What is a Test tube baby?
Answer: Test tube baby is formed through the technique of IVF followed by ET. In the test tube baby programme ova from the female and sperm from male are collected and induced to form zygote in the laboratory. This is called in vitro fertilisation. The zygote or early embryo (with up to 8 blastomeres) is then transferred into the fallopian tube. The embryo with more than 8 blastomeres is transferred into the uterus. This is called embryo transfer (ET). Further development takes place inside the body of the female.

Fig: IVF procedure

2. What is cryopreservation?
Answer: Cryopreservation is the process in which cells or gametes are stored at -196^o C in liquid nitrogen. Viability is retained even though it is generally recognised that viability using cryopreserved sperm is lower than that obtained with non frozen sperm. But this is useful in intracytoplasmic sperm injection.

3. Which are the different assisted reproductive technologies?
Answer: Assisted reproductive technologies is a set of medical procedures aimed at treating infertility. GIFT, IUT, ZIFT and ICSI are assisted reproductive technologies that help infertile couples to have children.

GIFT (gamete intra fallopian transfer) - It involves transfer of ovum and sperm into the female who cannot produce ovum but can provide a favourable environment for fertilisation and further development of the foetus
IUT - When the embryo with more than 8 blastomeres is transferred into the uterus in IVF. It is called intra uterine transfer (IUT).
ZIFT (zygote intra fallopian transfer) - In this method a zygote or embryo up to 8 blastomeres is transferred into the fallopian tube.
ICSI (intra cytoplasmic sperm injection) - It is a sophisticated reproductive technology in which sperm is directly injected into the ovum in a laboratory. The zygote develops into an embryo and the embryo so formed is then transferred into the female for further development.