Infertility is defined as the failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse. It affects approximately 9-15% of reproductive-aged couples worldwide. The main causes of infertility include female factors like PCOS, endometriosis, and tubal damage; male factors like low sperm count or quality; and unexplained infertility. Treatments for infertility include ovulation induction, intrauterine insemination, in vitro fertilization, and others. Religious views on assisted reproduction vary between religions, with some being more accepting than others.

6. Infertility:
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.
International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the
World Health Organization (WHO) revised “glossary of ART terminology”, Fertility and
Sterility, Vol. 92, No. 5, November 2009

7. The cumulative spontaneous pregnancy rate for a couple is
approximately 57% after three months, 72% after six
months, 85% after one year and 93% after two years.
Church, Elaine. "Obstetrics and Gynaecology: An Evidence‐based Text for MRCOG, edited by
David M Luesley, Philip N Baker." (2011): E206-E206.

8. It has been estimated that infertility affects 9% of
couples, of whom 70% suffer from primary infertility
i.e. no previous conception, and 30% secondary infertility
i.e. have achieved a previous pregnancy (regardless of the
outcome of that pregnancy).
Worldwide, more than 70 million couples suffer from
infertility, the majority being residents of the developing
countries.
Church, Elaine. "Obstetrics and Gynaecology: An Evidence‐based Text for MRCOG, edited by
David M Luesley, Philip N Baker." (2011): E206-E206.

9. Subfertility:
This term can be applied to most couples that are
described as infertile while they can actually conceive if
given enough time (more than 1 year). They represent 50%
of cases of infertility.

10. Infertility as a disability:
World Health Organization., & World Bank. (2011). “World report on disability”. Geneva,
Switzerland: World Health Organization.

11. Infertility as a disability:
Infertility generates disability (an impairment of
function), and thus access to health care falls under the
Convention on the Rights of Persons with Disability.
Infertility in women was ranked by WHO as the 5th
highest serious global disability (among populations under
the age of 60)..
World Health Organization., & World Bank. (2011). “World report on disability”. Geneva,
Switzerland: World Health Organization.

14. (Centres for Disease Control and Prevention, 2013. National Summary and Fertility Clinic
Reports. Atlanta, GA, 2013.)

15. Tubal factor infertility:
Congenital absent or secondary to surgery which cannot be
corrected by surgery and when surgery fails.
Ovulatory dysfunction:
In patients with polycystic ovarian disease (PCOS) and
other ovulatory problems.
Endometriosis:
Patients with endometriosis, often have tubal involvement
and ovarian cysts (endometrioma).
Uterine factor infertility:
Mullerian anomalies that requires a surrogate mother
(prohibited in Moslem countries).

16. Male infertility: due to poor quality semen parameters;
Azoospermia, oligozoospermia, asthenozoospermia, anti-
sperm antibody etc.
Age Related Infertility:
When woman's ovarian function is diminished with age. In
many cases, this reduced function can be overcome
through the use of IVF
Unexplained infertility:
after failure of ovulation induction and IUI.
Cervical factor infertility:
Hostile cervical mucus which cannot be treated by IUI.

19. all treatments or procedures that include the in vitro
handling of both human oocytes and sperm or of embryos
for the purpose of establishing a pregnancy. This includes,
but is not limited to, in vitro fertilization and embryo
transfer, gamete intrafallopian transfer, zygote
intrafallopian transfer, tubal embryo transfer, gamete and
embryo cryopreservation, oocyte and embryo donation, and
gestational surrogacy.

20. ART does not include assisted insemination (artificial
insemination) using sperm from either a woman’s partner or
a sperm donor.
International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the
World Health Organization (WHO) revised “glossary of ART terminology”, Fertility and
Sterility, Vol. 92, No. 5, November 2009

21. An estimated 1 in 7 couples (approximately 3.5 million in
the UK) have difficulty conceiving, and many of these
couples have IVF treatment. Every year about 12,000
babies are born using assisted conception treatment in the
UK, representing approximately 2% of all babies born
every year.
Church, Elaine. "Obstetrics and Gynaecology: An Evidence‐based Text for MRCOG, edited by
David M Luesley, Philip N Baker." (2011): E206-E206.

22. According to HFEA data 49,636 women had a total of
64,600 cycles of IVF and 2379 women had a total of 4611
cycles of donor insemination (DI) in 2013 in the UK.
Worldwide, about 1 million babies have been born as a
result of ART.
Church, Elaine. "Obstetrics and Gynaecology: An Evidence‐based Text for MRCOG, edited by
David M Luesley, Philip N Baker." (2011): E206-E206.

23. In vitro fertilization (IVF) and embryo transfer (ET):
is a process of fertilization an egg with sperm outside the
body, in vitro ("in test tube"). The process involves
monitoring and stimulating a woman's ovulatory process,
Ovum pick-up and letting sperm fertilize them in a liquid in
a laboratory. The fertilized egg (zygote) undergoes embryo
culture for 2–5 days, and is then transferred to the same
or another woman's uterus, with the intention of
establishing a successful pregnancy.

24. Intracytoplasmic Sperm Injection (ICSI)
It was first introduction in 1992, for those couples would
have not achieved fertilization or very low fertilization
rates using standard IVF techniques.
A single motile morphologically normal sperm is carefully
identified, picked up using a tiny pipette and carefully
injected directly into the cytoplasm (center) of each
mature egg. The fertilized embryos are allowed to develop
as for standard IVF prior to transfer.

27. Tubal factor infertility
Ovulatory dysfunction
Uterine factor infertility

28. Male infertility
Age Related Infertility
Unexplained infertility
Cervical factor infertility
Endometriosis

29. Indications of IVF other than infertility :
1.preimplantation genetic diagnosis (PGD) to rule out
presence of genetic disorders, Gender selection
2.Pregenetic screening (PGS)
3.egg donation and surrogacy "
; where the woman providing
the egg is not the same who will carry the pregnancy to
term. (Prohibited in Muslims countries)
4.Fertility preservation: oocyte, sperm and embryo
cryopreservation for further use , oocyte
cryopreservation can be used for women who are likely
to lose their ovarian reserve due to undergoing
chemotherapy
5.same-sex couples, single and unmarried parents (ethical
debate)

32. Gamete intrafallopian transfer (GIFT): Oocytes and
sperms are placed into the fallopian tube. The procedure is
applicable in patients who have normal fallopian tubes.
Zygote intrafallopian transfer (ZIFT):
The fertilized oocytes in the pronuclear stage (zygotes)
are placed into the fallopian tube. It has the same
indications as GIFT. In this case the male and female
pronuclei are seen in the cytoplasm.
Tubal embryo transfer (TET)
The embryos (zygotes after cleavage) are placed into the
fallopian tube.

33. Peritoneal oocyte and sperm transfer (POST):
The oocytes and sperms are placed into the pelvic cavity.
Subzonal insemination (SUZI):
A hole is made in the zona pellucida and 3-6 spermatozoa
are introduced into the subzonal space.
Intracytoplasmic sperm injection (ICSI):
A single sperm or spermatid is injected into the cytoplasm
of the oocyte under the control of the microscope.

38. 1931
Aldous Huxley published a science fiction novel called
“Brave New World”. In this novel , Huxley realistically
described the technique of IVF near we know now. in 1937,
The New England Journal of Medicine describes this as
“note worthy !!“.
Aldous Huxley
English novelist

39. 1958
Carl Gemzell obtained the first pregnancies following
treatment with human pituitary gonadotrophin (hPG) and
human menopausal gonadotrophin (hMG),
Carl Gemzell (1910 – 2007 )
Swedish physician and reproductive endocrinologist

40. 1958 – 1959
Min Chang succeeded in growing rabbit embryos derived
from oocytes fertilized in vitro, and in 1959 achieved a live
birth by transfer of an in-vitro-fertilized oocyte.
Dr. Min Chueh Chang (1908 – 1991 )
Chinese-born American reproductive
biologist

41. 1961
Palmer from France described the first retrieval of
oocytes by laparoscopy.
Palmer
French physician

42. 1973
The first IVF pregnancy was reported by the Monash
research team of Professors Carl Wood and John Leeton in
Melbourne, Australia. Unfortunately, this resulted in early
miscarriage
Carl Wood and John Leeton
Australian gynecologists

43. 1978
Louise Brown the first ever IVF baby occurred in Oldham,
England on July 25, 1978. This birth was the result of the
collaborative work of Patrick Steptoe and Robert Edwards
Sir Robert Edwards
British physiologist
Patrick Steptoe
British gynecologist
Awarded Nobel prize in 2010

44. Louise Brown
Louise Joy Brown, the first test-tube baby 1978

45. 1983
• First pregnancy after oocyte donation
• The first vaginal egg retrieval using an abdominal
ultrasound
1984
• First surrogacy embryo transfer baby born in California,
USA
• First report on pregnancy following translaparoscopic
gamete intrafallopian transfer “GIFT”

46. 1985
Human pregnancy by in vitro fertilization (IVF) using sperm
aspirated from the epididymis
1986
First report on pregnancy after translaparoscopic zygote
intrafallopian transfer “ZIFT”
1989
First report on biopsy of human preimplantation embryos
and sexing by DNA amplification

47. 1992
• The first pregnancy after intracytoplasmic sperm
injection “ICSI”
• Successful in-vitro fertilization and embryo transfer
after treatment with recombinant human FSH

48. 2016
the world's first three-parent baby using the spindle
transfer technique of mitochondrial replacement.
John Jin Zhang
Chinese American medical scientist

49. Kamel RM. Assisted reproductive technology after the birth of Louise Brown. Journal
of reproduction & infertility. 2013 Jul;14(3):96.

50. Kamel RM. Assisted reproductive technology after the birth of Louise Brown. Journal
of reproduction & infertility. 2013 Jul;14(3):96.

51. Kamel RM. Assisted reproductive technology after the birth of Louise Brown. Journal
of reproduction & infertility. 2013 Jul;14(3):96.

52. Kamel RM. Assisted reproductive technology after the birth of Louise Brown. Journal
of reproduction & infertility. 2013 Jul;14(3):96.

53. Bourn Hall worlds first IVF Conference 1982

54. Bourn Hall worlds first IVF Conference 1982

57. Assisted reproduction in Judaism
14 million people around the world that identify themselves
as Jewish represent 0.2% of the global population.
three sects of Judaism exist: (1) the Orthodox Jews who
form about 10%, (2) the conservative Jews, who form
about 5% and (3) the reformed Jews who form the
majority at about 85%
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views & vision in
ObGyn. 2016 Mar 3;8(1):33.

58. Assisted reproduction in Judaism
in general, if IVF is mandatory, it is allowed as Jews have
an obligation to “be fruitful and multiply”.
PGD and PGS are also allowed because the soul does not
enter the body until 40 days (Halacha = Kosher).
Selective reduction is acceptable as it enhances the
possibility of life as determined by doctors.
Embryo research to promote life is also acceptable as well
as therapeutic cloning and any research, which can promote
lifesaving treatment

59. Assisted reproduction in Christianity
Christians form about 31.5 % of the world population (2.2
billions). A number of various churches exist within
Christianity and each one of them reacted differently to
assisted reproduction. Most of these churches are opposed
to assisted reproduction, although some of them are more
fiercely opposed than others
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views & vision in
ObGyn. 2016 Mar 3;8(1):33.

60. Assisted reproduction in Christianity
the Catholic Church :
all forms of assisted reproduction including IUI, IVF,
ICSI, ET and surrogate motherhood are not accepted.
IUI can be accepted if the semen is collected by sexual
intercourse while AID is forbidden because it involves a
third party.

61. Assisted reproduction in Christianity
the Catholic Church :
Moreover, the Catholic Church offers its respect and
protection to the human being starting with its first
seconds of existence; it therefore considers research on
embryos, cryopreservation and abortion strongly
disapproves
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views & vision in
ObGyn. 2016 Mar 3;8(1):33.

62. Assisted reproduction in Christianity
Protestantism:
Protestants vary in their beliefs on IVF, and unlike the
Catholic Church, there is not one set of ethical guidelines
for Protestant couples to follow regarding its use. Those
who support IVF, limit its use to married couples. All the
embryos must be replaced into the uterus and selective
reduction is not allowed.
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views &
vision in ObGyn. 2016 Mar 3;8(1):33.

63. Assisted reproduction in Christianity
Eastern Orthodox Churches:
The Eastern (Greek) Orthodox Church is not as strict as
the Roman (Latin) Catholic Church regarding assisted
reproduction. It allows the medical and surgical treatment
of infertility including IUI using the husband’s sperm but
cannot accept IVF and other assisted reproductive
techniques, surrogate motherhood, donor insemination and
embryo donation.

64. Assisted reproduction in Christianity
the Coptic Church:
According to theological studies, Coptic culture and
scientific research, IVF is accepted as long as the oocyte
and sperm are taken from the husband and wife,
fertilization occurred in vitro with no doubt about gamete
mixing. Embryo transfer must be performed to the mother
who is the source of the oocytes. Artificial insemination
with the husband’s sperm (AIH) is also accepted, but
gamete donation is not.

65. Islam and assisted reproduction
Muslims (followers of the religion of Islam) form about
22.3% of the world population (1.6 billions). According to
the Muslim tradition, Islam is not only a religion, but also a
way of life, as the teachings of Islam cover all the fields
of human activity
slamic scholars like to highlight the fact that Islam is a
religion of ease (Yusr) and not hardship

66. Islam and assisted reproduction
Sunni Islam:
According to these Fatwas and guidelines of Sunni Islam,
all forms of assisted reproduction are allowed as long as
the sperm and oocyte are those of the husband and his
wife and the embryo is replaced into the wife’s uterus
during an existing marriage contract (which ends by death
or divorce).
Cryopreservation of spermatozoa and oocytes is also
allowed as well as cryopreservation of embryos. T

67. Islam and assisted reproduction
Sunni Islam:
These embryos remain the property of the couple and may
be transferred to the same wife in a subsequent cycle but
only during the validity of the current marriage.
Research on embryos younger than 120 days is also allowed
as according to the Quran, the “soul” enters the body of
the foetus after 120 days

68. Islam and assisted reproduction
Sunni Islam:

69. Islam and assisted reproduction
Sunni Islam:

70. Islam and assisted reproduction
Shi’a Islam:
Shi’a form about 10% of Muslims.
The practice of assisted reproduction in Shi’a Muslim
communities follows the Fatwa issued by Ayatollah Ali
Khamenei in 1999. The Shi’as principles and practice are
similar to the Sunni Fatwas except in one important
difference: Shi’as allow gamete donation.
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views &
vision in ObGyn. 2016 Mar 3;8(1):33.

71. Assisted reproduction in Hinduism
There are about 1 billion Hindus around the world,
representing 15% of the global population
Hinduism is a very liberal religion concerning assisted
reproduction. In fact the Hindu religion agrees with most
of the assisted reproduction techniques, but it demands
that the oocyte and the sperm used in the procedure to
(better) come from a married couple.

72. Assisted reproduction in Hinduism
However, Hinduism also accepts sperm donation but the
donor has to be a close relative of the infertile husband.
In addition, abortion is not prohibited and the adoption of
a child, which usually comes from a numerous family, is also
practiced. This liberal attitude has made India an
important destination for reproductive tourism and many
couples travel to India for assisted reproduction.
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views &
vision in ObGyn. 2016 Mar 3;8(1):33.

73. Assisted reproduction in Buddhism
There are about 488 million Buddhists worldwide,
representing 7% of the world’s total population.
Buddhism is also a very liberal religion regarding assisted
reproduction. It allows the use of IVF without restricting
the access to this medical procedure to the married
couples and sperm donation is also permitted. In the
Buddhist tradition, a child conceived from donated genetic
material has the right to meet his genetic parents as he
reaches maturity
Sallam HN, Sallam NH. Religious aspects of assisted reproduction. Facts, views &
vision in ObGyn. 2016 Mar 3;8(1):33.

77. The IVF/ICSI Cycle:
1. Initial Evaluation
2. Pre-stimulation preparation
3. Down regulation of pituitary hormones
4. Ovarian stimulation
5. Monitoring follicle development with ultrasound and
serum hormone levels
6. Final oocytes maturation and hCG administration

78. The IVF/ICSI Cycle:
7. Transvaginal ultrasound-guided oocyte retrieval
8. Fertilization in vitro
9. Embryo transfer
10. Luteal phase support
11. Pregnancy test and early pregnancy follow-up