Infertility can be caused by issues with sperm production, erectile dysfunction, or structural abnormalities in males. In females, infertility may be due to problems with ovulation, fallopian tubes, uterine lining, or advanced age. Assisted reproductive technologies (ART) help overcome infertility through techniques like artificial insemination, in vitro fertilization, and surrogacy. ART involves stimulating a woman's ovaries, retrieving eggs, fertilizing them with sperm, and transferring embryos into the uterus, potentially helping many couples achieve pregnancy.

1. ASSISTED REPRODUCTIVE TECHNOLOGY
K.BHAVANA
2ND BIOTECHNOLOGY
P.R.GOVT (A) COLLEGE,KAKINADA

2. INFERTILITY :
 According to WHO
Clinically infertility is defined as inability to conceive after more than a year of
intercourse without contraception.
 It may be seen in both male and female.

3. Reasons for infertility
Reasons for infertility in male:
 The different factors that causes infertility in male are –
 Sperm production/sperm count disorders – include azospermia( no sperm
cells are produced) and oligospermia( few sperm cells are
produced).sometimes sperm cells are malformed or they die before they
reach the egg.
 Erectile dysfunction
 Structural abnormalities- Either the shape or motility of the sperm is
affected .
 Age- The age of the male individual is also a major cause of infertility.

4. Reasons for infertility in female
There are number of factors that causes infertility in female.
 Ability of the ovaries to produce ova e.g ovulation disorders that may
prevent an egg from being released such as polycystic ovarian syndrome
(PCOD).
 Fallopian tube structure e.g. Tubal blockage which prevents ovum and
sperm meeting.
 Advanced maternal age is a major cause of infertility in women. The quality
of a ovum decrease with the age and can limit her ability to conceive.
 Quality of uterine lining e.g. Endometriosis, in which womb tissue invades
and damages neighbouring reproductive tissues.

5. ASSISTED REPRODUCTIVE TECHNOLOGY
Definition
 Assisted reproductive technology is defined as the
technology used to achieve pregnancy in
procedures such as artificial insemination , in
vitro fertilization and surrogacy.

6. TECHNIQUES OF A.R.T
Main three techniques of A.R.T :
1. ARTIFICIAL INSEMINATION
2. IN VITRO FERTILIZATION
3. SURROGACY

7. 1. ARTIFICIAL INSEMINATION
It is a deliberate introduction of sperm into the
female’s uterus or cervix for the purpose of achieving
pregnancy through in vivo fertilization by means other
than sexual intercourse.

8. Types of artificial insemination
1. Intracervical insemination
2. Intrauterine insemination
3. Intratubal insemination

9. INTRACERVICAL INSEMINATION
 It involves injection of unwashed or raw semen into the
in cervix with the needleless syringe.
 A vaginal speculum is used to hold open the vagina so
that cervix may be observed and the syringe is inserted
,the plunger is pushed forward and the semen is
emptied deep in the vagina.

10. INTRAUTERINE INSEMINATION
 The semen is washed with special media injected inside the
uterus with catheter after stimulating the ovaries to produce
more eggs per cycle.
 The catheter used here is known as “TOM CAT”

11. INTRATUBAL INSEMINATION
 It involves injection of the washed sperm into the fallopian
tube.
 It should not be confused with the GIFT, where both the eggs
are mixed outside the women’s body and then immediately
inserted into the fallopian tube.
 Less used then IUI.

12. INVITRO FERTILIZATION
 In vitro fertilization is the uniting of egg and sperm in vitro ( in the
lab). Subsequently the embryos are transferred into the uterus
through the cervix and pregnancy is allowed to begin.
 It is the technique of letting fertilization of male and female
gametes occur outside the female body.

13. History of IVF
 1890 – The very first in vitro manipulation of eggs/ embryos was
performed by Walter Heape, He transferred in vivo fertilized
eggs from one female rabbit to another.
 1959 – M.C. Chang, successfully conducted IVF in rabbits.
 February 15, 1969. The journal Nature published a paper
authored by R.G.Edwards , B.D. Bavister and P.C. Steptoe :
“Early stages of fertilization in vitro of human oocytes matured in
vivo”
 1977, the first IVF pregnancy in human , and the first test tube
baby was Louise Brown.

15. STEPS OF INVITRO FERTILIZATION
 There are generally five major steps in the process of
IVF :
1. Ovary stimulation
2. Oocyte retrieval
3. Sperm retrieval – wash sperm
4. Fertilization
5. Embryo transfer

17. Ovary stimulation
 Different hormones are given to female in order
to stimulate the formation of more than one
ovum.
 Formation of more than one ovum increases the
probability for getting a healthy embryos.
 Drugs or hormoneslike clomiphene(clomid),
hMG(pergonal),FSH/LH

19. Oocyte retrieval
 It is a technique used to remove Oocyte from the ovary of the
female enabling fertilization outside the body.
PROCEDURE :
 Under ultrasound guidance, the operator inserts a needle through
the vaginal wall and into an ovarian follicles, taking care not to
injure organs located between the vaginal wall and the ovary.
 The other end of the needle is attached to a suction device.
 Then the follicular fluid and cellular material is suctioned with
the needle.
 The procedure usually lasts 10-20 minutes

21. Sperm retrieval
 Approximately three hours before the procedure, the
semen sample from the male donor is obtained. The
sperm Is then washed and prepared for loading into the
same catheter into which several of the female’s best
eggs will be placed.
 The eggs are obtained by transvaginal needle aspiration (
no surgical incision) via an ultrasound.

22. FERTILIZATION
 After the retrieval of sperm, eggs and sperm are brought
together in a laboratory glass dish to allow the sperm to fertilize
an egg. If sperm parameters are normal, approximately 50,000 to
1,00,000 motile sperm are transferred to the dish containing the
eggs. This is called standard insemination . once fertilization
takes place one or more healthy embroyos are transferred to the
uterus .
 The ICSI technique is utilized to fertilize mature eggs is sperm
parameters are abnormal. This procedure is performed under a
high – powered microscope.

24. GAMETE INTRA FALLOPIAN TRANSFER
(GIFT)
 It is a tool of assisted reproductive technology against
infertility. Eggs are removed from a woman's ovaries, and
placed in one of the fallopian tube, along with man’s
sperm.
 It takes on average four to six weeks to complete the
cycle of GIFT.

25. ADVANTAGES
 There is no much human intervention in the actual
fertilization of the eggs.
 Because fertilization takes place within the fallopian
tube, GIFT offers an option for people whose religious
beliefs prohibit conception outside the body.
DISADVANTAGES
 Can be performed only if woman have atleast one normal
fallopian tube.
 GIFT involves a laproscopic surgery

26. ZYGOTE INTRA FALLOPIAN TRANSFER
(ZIFT)
 It 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
fertilized . The resulting zygote is placed into the
fallopian tube by the use of laproscopy.
 It has the success rate of 64.8 % in all the cases.

27. ADVANTAGES
 Fertilization can be confirmed before they are implated into the
fallopian tube.
 Allows a developing embryos to travel into the uterus on its own,
which may be important to those who wish their baby to develop as
naturally as possible
DISADVANTAGES
 Can be performed only if woman have atleast one normal fallopian
tube.
 It is more expensive than GIFT
 ZIFT involves a laproscopic surgery

28. INTRA CYTOPLASMIC SPERM INJECTION
(ICSI)
 Sperm is injected directly into the eggs in a laboratory.
 Used if infertility originates from the male such as:
- low sperm count
- low sperm motility.
 Single spermatozoa is directly injected into the cytoplasm of the
oocyte through the micropuncture of zona pellucida.

29. ADVANTAGES
 Can be useful when very low numbers of motile sperm are
present and when there are problems with sperm binding
and penetration.
DISADVANTAGES
Altering the nature’s selection process for sperm can lead to
an increase risk of developmental and health issues for ICSI
children, as well as a higher risk of miscarriage because of
the poorer genetic material involved.

30. SURROGACY
 Surrogacy is when another women carries and gives birth
to a baby for the couple who want to have a child.
 It is the carrying of a pregnancy for intended parents
 In this a women agrees to became pregnant and deliver a
child for a contracted party.

31. TYPES
1. Traditional surrogacy: It is the simplest and least
expensive form of Surrogacy and is also know as
artificial insemination. The surrogate mother used an
insemination kit to became pregnant using an intended
father’s semen.
2. Gestational surrogacy : It is physically more
complicated and more expensive. Here both the eggs and
sperm are taken from intended father and mother

32. CONCLUSION
 ART has been the answer for many childless
couples, resulting in successful pregnancies and
child birth.
 Today there is a range of infertile treatment that
aims to ensure a healthy sustainable pregnancy.
 But there are still risks, stress and high cost
associated with ART.
 With the advent of new technologies, it is hoped
that these shortcomings would be overcome in
the near future and every infertile couple would
have the privilege of parenthood.