PREPARED BY:

S.NO NAME REGISTRATION

NUMBER
1 ANSAR K M HIMBRAN 20ETEC004004
2 DEEPAK U 20ETEC004013
3 G BHAGYALAKSHMI 20ETEC004017
4 KRUTHIKA B S 20ETEC004025
5 MADHURA J GOUDA 20ETEC004026
6 MALLIKARJUN 20ETEC004027
7 MOHAMMED OMER FAROOQ 20ETEC004031

DATE: 28th JUNE 2021

PREPARED FOR: MRS. ROOPA S PATIL
1
TITLE OF CONTENTS: Page No.
Executive Summary: 03

Table of contents:
1. Introduction 04
2. Conclusion 05
3. Recommendation 06
4. Discussion 08
4.1 Definition of infertility 08
Types of infertility 08
Reasons of infertility 11
4.2 Articles related to infertility 14
4.3 Strategies to treat infertility 17
IVF – IN VITRO FERTILISATION 17
ICSI – INTRA CYTOPLASMIC SPERM INJECTION 17
IUT – INTRA UTERINE TRANSFER 19
ET – EMBRYO TRANSFER 20
IUI – INTRA UTERINE INSEMINATION 21
GIFT – GAMETE INTRA FALLOPIAN TRANSFER 24
ZIFT – ZYGOTE INTRA FALLOPIAN TRANSFER 26
5. Infertility treating strategies in various parts of the
World. 28
6. Bibliography 31

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Executive Summary:
Biomedical engineering (BME) or
medical engineering is the application of engineering
principles and design concepts to medicine and biology for
healthcare purposes. Biomedical engineering is traditionally
known as “bioengineering”. This field seeks to close the gap
between engineering and medicine, combining the design and
problem solving skills of engineering with biological medical
sciences to advance health care treatment, including
diagnosis, monitoring and therapy.
“Infertility in developing countries raises
distinct and complex problems beyond those well known to
developed nations. The effects of infertility and the
concomitant need for its health care management relate to
the cultural realities of specific regions. While the relevance
and the need for assisted reproduction may be readily
established, some challenges their use in developing nations.
The criticism is levelled on two grounds: First, given the
overpopulation problem in many developing countries, it is
argued that over fertility, rather than infertility, should be the
focus of family planning programmes; and, Second, treating
infertility through expensive treatments cannot be justified in
low resource settings where other more pressing must be
given priority.”

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 1. Introduction:
Infertility is a condition affecting one fifth to one
sixth of couples in reproductive age. Within the field of
reproductive health, infertility implies a deficiency that does
not compromise the physical integrity of the individual, nor it
is life-threatening. However, such deficiency may negatively
impact the development of the individual, bringing about
frustration and weakening the personality, since most couple
consider having children as a vital objective. As compared to
other species, the human being is highly inefficient in terms of
reproduction. In the area of reproductive health, problems
tend to be different in each country. Hence, knowledge about
the prevalence of infertility to establish the potential needs of
the population and adapting health care to each particular
population is of considerable interest.
Availability, access, and quality of interventions
to address infertility remain a challenge in most countries.
Moreover, a lack of trained personnel and the necessary
equipment and infrastructure, and currently high cost of
treatment medicines, are major barriers even for countries
that are actively addressing the needs of people with
infertility. While assisted reproductive technologies (ART)
have been available for more than three decades, with more
than 5 million children born worldwide from ART interventions
such as in vitro fertilization (IVF), these technologies are still
largely available.

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2. Conclusion:
Infertility in recent years has emerged as one of the most
common health issues that many young couples have been
facing. The lifestyle with minimum physical activity, rising
stress level and irregular sleep pattern are few of the
reasons that, according to many clinicians and health
experts, are causing infertility, thus forcing them to opt for
artificial way of conceiving. Infertility by itself does not
threaten the life, but it has devastating psycho-social
consequences on infertile couples. It remains a worldwide
problem challenge. Management of infertility is still a
difficult medical task not only because of the difficulty in the
diagnosis and treatment of the reproductive disorders but
also of the fact that success of treatment is clearly
identifiable entity.
The infertile couples could be assisted to have children
through certain special techniques known as assisted
reproductive technologies simply knows as ART are
treatments that deals with both sperm and eggs of a couple.
It allows couple to decide if they wish to continue with the
pregnancy considering the procedures occurs before
implantation. There are many techniques in ART, these
techniques allow couples to have biological children who
might not have been able to conceive before.

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3. Recommendation:
Infertility education:
1. Public programmes relating to an understanding of
infertility, MAR care and access to relevant services
should be developed as part of SRH education. (To
include: recognition of infertility (or subfertility) as a
result of obesity, smoking, delayed childbirth (men and
women), increased sexual activity/partners without use
of barrier methods, early menopause due to family
history, cancer before or during reproductive years, and
other factors.)
2. Support for development of an infertility tool for
providers. Assistance of NGOs including IFFS in
conducting training workshops for providers.
Management of infertility by governments, public policy
and advocacy:
1. Infertility services covering a comprehensive range of
fertility strategies should be complementary to
population policies and programmes of maternal and
child health and SRH.
2. Equitable access to affordable, quality MAR care should
contribute to public health and become government
policy in all countries with summary data, as a minimal
standard, to be regularly published.

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 3. Infertile patient organizations should be involved in
patient education, publicity and advocacy. Advocacy of
reproductive rights in the area of infertility is essential
to gain community, professional and government
support.
MAR data governance and surveillance:
1. Quality control is needed in the delivery of ART
2. All international and national data collection for ART
should use the ICMART glossary definitions.
3. The glossary should be made available for translation
4. Surveillance of ART should be ongoing.
5. A capacity for national reporting of all MAR data should
be developed to monitor MAR treatment and outcome
in each country performing MAR care.
6. ICMART should be the principal organization to develop
and promote global surveillance of ART and should be
the global repository of those data.
Prevention, prevalence and burden of disease:
1. Prevention of infertility should continue to be one of the
major objectives of STI programmes.
2. Cross-cultural epidemiological and social science research,
using standard definitions of infertility, should be done to
better understand the levels of prevalence, the need and
demand for, and the access to fertility diagnosis and
treatment services.
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 3. Discussion:

4.1) Definition of infertility:

Infertility is a disease of reproductive system
defines by the failure to achieve a clinical pregnancy after 12
months or more of regular unprotected sexual intercourse.

Types of infertility:
1. Female infertility:

Ovulation problems: The menstrual cycle functions by

several gland and their hormones working in harmony.
For ovulation to occur, a part of the brain called the
hypothalamus prompts the nearby pituitary gland to
secret glad to secrete hormones that trigger the ovaries
to ripen egg. Irregular or absent periods indicate that
ovulation may be irregular or absent too. The age of the
woman is a significant fertility factor. The chance of
pregnancy for a woman aged 40 years is only 5% per
menstrual cycle.

Polycystic ovary syndrome: At ovulation, the ovaries

produce small cysts or blisters called follicles. Typically,
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one follicle ripens to release an egg. In polycystic ovary
syndrome (PCOS), the follicles fail to open, instead
forming little cysts at the periphery of the ovaries which
often release male sex hormones. This means that
woman’s ovulation and periods are irregular or don’t
happen at all.

Problems with fallopian tube: The sperm fertilizes the

egg on its journey down the fallopian tube. A blocked or
scarred fallopian tube may impede the egg’s progress,
preventing it from meeting up with sperm.

Problems with uterus: The fertilized egg lodges(implants)

in the lining of the uterus. Some uterine problems that
can hamper implantation include:
Fibroids: non-malignant tumors inside the womb
Polyps: overgrowth of the endometrium, which can be
prompted by the presence of fibroids.

Problems with the cervix: At the top of the vagina is the

neck or the entrance to the uterus, called the cervix.
Ejaculated sperm must travel through the cervix to reach
the uterus and the fallopian tubes. Cervical mucus around
the time of ovulation is normally thin and watery so that
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 sperm can swim through it. However, in some women the
cervical mucous is thick and this can hinder the sperm.

Endometriosis: This is a condition in which cells from the

mining of the uterus migrate to the other part of the
pelvis. It can damage the fallopian tubes and the ovaries,
and affect the movement of egg and sperm.

2. Male infertility:

Sperm disorders: Sperm problem can be from traits the

person born with. Lifestyle choices can lower sperm
numbers. Damage to the reproductive system can cause
low or no sperm. About 4 out of every 10 men with total
lack of sperm have an obstruction within the tubes the
sperm travel through.

Varicocels: These are the swollen veins in the scrotum.

They found in 16 out of 100 of all men. They harm sperm
growth by blocking proper blood drainage. The testicles
are too warm for making sperm. This can cause low sperm
numbers.

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 Retrograde Ejaculation: This is when semen goes
backward in the body. They go into the bladder instead of
coming out the penis. This happens when nerves and
muscles in the bladder don’t close during orgasm.

Immunologic infertility: Sometimes a man’s body makes

antibodies that attack his own sperm. Antibodies are
most often made because of injury, surgery or infection.
They can make it hard for sperm to swim to the fallopian
tube and enter an egg.

Obstruction: Sometimes the tubes through which the

sperm travel can be blocked. Repeated infections,
surgery, swelling or developmental defects can cause
blockage. Any part of the male reproductive part can be
blocked.

Reasons of infertility:
There is an increasing body of evidence that
health behaviours affect fertility. As most health behaviours
can be modified, providing advice and support in making
healthy changes can promote fertility. The evidence relating to

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the effects on fertility of caffeine, alcohol consumption and
smoking is reviewed here.

Caffeine:
Caffeine is widely consumed as
it is present in coffee, tea, some soft
drinks and chocolate. Some evidence
suggests that the consumption of
caffeine, with a possible dose-response
effect, may prolong the time to
pregnancy and affect the health of a
developing foetus, although the mechanism for this is unclear.
Caffeine consumption was recorded at regular intervals as
well as daily information regarding menstrual bleeding and
intercourse until pregnancy occurred. Women who consumed
less than one cup of coffee were twice as likely to become
pregnant, per cycle, as moderate coffee drinkers and the risk
of not becoming pregnant increased with higher consumption.
Other studies have also suggested an association between
caffeine intake and increased time to conception that may be
dose-response related.

Alcohol:
Alcohol has been
shown to affect male
and female fertility, but
the level of consumption
associated with risk is
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unclear. Although an adverse effect on fertility of any amount
of alcohol consumption is highly plausible, studies are limited,
as they must generally rely on recall of levels and timing of
alcohol consumption. High levels of maternal alcohol
consumption are known to be dangerous to the unborn child,
but the effects at lower levels are less certain.

Smoking:
There is strong evidence
that smoking adversely affects male
and female fertility. Smokers are
more likely to be infertile and
women who are exposed to smoking
take longer to conceive. Furthermore,
maternal smoking increases the risk
of low birth weight and birth defects and women who smoke
reach menopause earlier than non-smokers. Smoking can also
damage sperm DNA. Heavy smoking (≥20 cigarettes per day)
by fathers at the time of conception increases the child’s risk
of childhood leukaemia and shortens reproductive lifespan of
daughters.
Caffeine and alcohol consumption adversely affect
fertility, most likely in a dose-dependent way. Both active and
passive smoking reduce male and female fertility and are
harmful for the growing baby. In ART populations male and
female smoking significantly reduce conception and live birth
rates and increase the risk of miscarriage.alth Special Interest
Group
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4.2) Articles related to infertility:

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15
16
4.3) Strategies to treat infertility:
IVF – IN VITRO FERTILISATION:
In Vitro Fertilization (IVF)
is a type of assisted
reproductive technology
(ART), started in 1978.
IVF is a complex series of
procedures used to help
with the fertility or
prevent genetic problems
and assist with the conception of the child.
During IVF, mature eggs are collected from ovaries and
fertilized by a sperm in a lab. Then the fertilized egg is
transferred to the uterus. One full cycle of IVF takes about
three weeks. Sometimes these steps are split into different
parts and the process can take longer.
The advantage of IVF is achieving a successful pregnancy and a
healthy baby. IVF can make this a reality for people who would
be unable to have a baby otherwise having problems in their
reproductive organs. This technique has been used for a long
time and has a safe track record

ICSI – INTRA CYTOPLASMIC SPERM INJECTION:

1. It was first come into action act 1987, and this experiment
was success at January 14,1992
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2. It is another specialized procedure to form an embryo in
the female reproductive parts by injecting the sperm into
the ovum
3. This problem is mainly found in the male partner, this is
due to the very low sperm count in the male ejaculates
4. Infertility cases either due to the inability of the male
partner to inseminate the female
5. The main procedure of this method is made at the clinic
(or) laboratory
6. A tiny needle called micropipette is used to inject the
single sperm into the female egg
7. This procedure takes atleast four to six weeks to complete
the entire ICSI cycle
8. The fertilised egg grows in the laboratory for a week
before it is transferred into the male uterus
9. But this procedure have only 50-70% success rate

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IUT – INTRA UTERINE TRANSFER:
It is a technique in which an Embryo with more than eight
blastomers stage is transferred into the uterus for gaining
nutrition and to complete its further development of zygote
and embryo .

Once the embryos have grown to predetermined size, one or

two are transferred to the woman’s uterus at appropriate
time of her menstrual cycle. The embryos chosen for transfer
are loaded into a transfer catheter which is passed through
the cervix into uterus under ultrasound guidance. It is painless
and involves no anesthetic. The good quality embryos that are
not transferred are frozen and stored which can be used in
subsequent cycles if the first cycle is not successful. Two
weeks after the transfer of embryo into uterus, blood test is
done to determine if the woman is pregnant or not.
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ET – EMBRYO TRANSFER:
1. Embryo transfer refers to a step in the process of assisted
reproductive in which embryos are placed into the uterus
of a recipient female from a donor female to establish a
pregnancy.
2. This technique is often used in connection with IVF which
was first performed in 1984
3. Embryo transfer can be done at day 2 or day 3 or later in
the blastocyst.
Steps in Embryo transfer technology:

Applications of embryo transfer:

1. Faster genetic improvement
2. Genetic engineering and production of clones
3. Genetic screening
4. Circumention of infertility

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IUI – INTRA UTERINE INSEMINATION:
The entire male ejaculate is normally deposited in the vagina.
A large proportion of the sperm are
immediately destroyed, a few sperm survive and swim past
the cervix, into the uterus and eventually into
the fallopian tubes to fertilize the egg. IUI is a type of artificial
insemination in which there is a transfer of
many motile (actively swimming) sperm, through the cervix
and directly into the uterus.

IUI PERFORMANCE
1. IUI increases the number of sperm arriving at the site of
fertilisation because a high concentration of sperm are
deposited at the top of the uterus rather than in the
vagina.
2. IUI can benefit couples where the male partner has
decreased sperm count or decreased sperm motility.
3. Thick cervical mucus or antisperm antibodies are
additional indications for the use of IUI
4. In addition, the preparation of the ejaculate, prior to IUI,
removes seminal plasma from the sperm cells
5. This plasma may, in some circumstances, contain
infectious organisms or toxic substances that impair the
fertility of the sperm cells. IUI is also utilized when
couples are requesting donor sperm

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NEED FROM DONOR SPERM
1. All therapeutic donor insemination procedures at
Fertility Associates of Memphis are performed under
the guidelines outlined by the American society for
Reproductive Medicine and the American Academy
of Tissue Banks
2. Therapeutic Donor Insemination (TDI), you will
undergo screening for rubella, HIV, cytomegalovirus
antibody IgG and IgM, hepatitis B and C, Chlamydia
and gonorrhea as well as blood typing
3. Your husband will need HIV, cytomegalovirus
antibody IgG and IgM, hepatitis B and C and
bloodtype testing. 22
BENEFITS
The success rates reported with IUI depend upon whether it is
used alone or in conjunction with ovulation induction
medications. It will also vary depending upon the couple’s
diagnosis and the husband’s initial sperm count. Expected
pregnancy rates per treatment cycle (month) are listed. These
rates generally decline after the third or fourth attempt if a
pregnancy was not achieved; your doctor will recommend a
different therapy to increase your chances of pregnancy.
1. Donor insemination with thawed cryopreserved sperm – 10
to 15%
2. Abnormal husband’s sperm count – 10 to 15%
3. Cervical mucus factors – 10 to 15%
4. Antisperm antibodies – 10 to 15%
5. Unexplained infertility with clomiphene citrate – 5 to 10%
SIDE EFFECTS
1. Uterine cramping – This is minimized by sperm processing
and the insemination of small volumes into the uterus.
However, in certain patients where there is difficulty
passing the catheter into the uterus, some transient
uterine cramping may be experienced. This usually
persists for the time period during the insemination and
for approximately 5 to 10 minutes afterwards.
2. Pelvic infection resulting from the insemination – This
small risk is further minimized by sperm processing. If the
laboratory notices a significant amount of bacterial

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 contamination within the sperm specimen, the physician
and patient both will be notified and the proper course of
action discussed.

CONCLUSION
We offer IUI to our patients who suffer from certain types of
infertility. In some cases this type of treatment is able to
diagnose certain problems related to fertility (poor response,
unhealthy eggs or (endometrium). Your physician may
recommend a different therapy if problems are discovered.
The overall benefit is an improved pregnancy rate above what
the couple can expect without this therapy. The risk of
adverse consequences is small. In general, the maximum
benefit is achieved after 3 or 4cycles.

GIFT – GAMETE INTRA FALLOPIAN TRANSFER:

1. GIFT is an early, and very simple ART technique devised

in the year 1980s to achieve pregnancies in most couples
who have not been able to conceive using conventional
treatments for infertility.
2. GIFT stands for “ Gamete Intra-Fallopian Transfer.”
Generally it works on female’s eggs and the male’s
sperms, are washed and placed via a catheter directly into
the woman’s fallopian tubes.
Hence, this involves a minor surgical procedure and also the
fertilization takes place inside the
women’s body.
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 3. The GIFT technique follows nature by allowing the eggs to
fertilize and develop in the natural environment of the
fallopian tube, and then to make their way to the uterus
for implantation according to a normal timetable.

WORKING OF GIFT
The fluid containing the eggs is placed in a laboratory dish and
observed under a microscope. The egg is located and its stage
of maturity noted. It is then carefully cultured in a special
nutrient. Sperm and eggs are sequentially loaded into the
catheter, which is then introduced into the patient’s fallopian
tube through a tiny incision in her abdomen.

CHANCES FOR PREGNANCY

1. GIFT is not early as popular as IVF today; nonetheless
there is still a 50% pregnancy rate per retrieval cycle for
GIFT
2. Success chances of GIFT is even somewhat higher than
with standard IVF (in vitro fertilization), but GIFT can be

25
 performed only if the patient has normal fallopian tubes
and adequate sperm.
BENEFITS/ADVANTAGES
This technique relies to a far greater degree on the body’s
natural processes and timetable to produce pregnancy.
It is acceptable to those religious groups which avoid the more
embryo invasive technologies.
In technical IVF terms, we would say that it is the best of all
methods of “co-culture”.
If an older woman is fortunate enough to yield many eggs, her
pregnancy rate can be made equivalent to
that of a younger patient by putting in more eggs.

ZIFT – ZYGOTE INTRA FALLOPIAN TRANSFER:

Zygote intra fallopian transfer (ZIFT) is an assisted

reproductive technology (ART) first used in 1986 to help those

26
who are infertile conceive a child. ZIFT is a hybrid technique
derived from a combination of in vitro fertilization (IVF) and
gamete intrafallopian transfer (GIFT) procedures. Despite a
relatively high success rate close to that of IVF, however, this
technique is more natural because the fertilized egg (the
zygote) is placed in the woman’s body for implantation much
sooner than with IVF.
This particular technique is used for the
women who haven’t been able to get pregnant with normal
IVF, and then ZIFT is a good idea. ZIFT can treat many types of
infertility, except in cases where there is a damage to the
fallopian tube. This can also be used in cases of mild male
infertility like ejaculation problem, low sperm count etc.
The term ‘intrafallopian’ means ‘inside the
fallopian tube’. Thus the term ‘ZIFT’ refers to the transfer of a
zygote into a fallopian tube. The procedure involves retrieving
an egg from the women, combining with the sperm in the lab.
The egg and sperm are fertilized in a petridish, a multi-
purpose glass or plastic container with a lid. The fertilized egg
is implanted in one of her fallopian tubes. This process goes
more quickly than other techniques as the fertilized eggs
(zygote) are placed in fallopian tube within 24 hours. But this
process requires an extra surgical procedure called
laparoscopy. Advantage of this technique is the fertilization
will be confirmed as it occurs outside the body.
Actually, GIFT or ZIFT gives a considerably higher pregnancy
rate in older women with cervical
abnormalities.
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5.Infertility treating strategies in various parts of the
world:

INDIA:
As per Census 2011, the Gender ratio of India is 943
females per 1000 males. There are 949 females to 1000 men
in rural areas, while in an urban area, there are 929 females to
1000 males.
According to World Health Organization estimate the
overall prevalence of primary infertility in India is between 3.9
to 16.8%. In Indian states prevalence of infertility varies from
state to state such as 3.7 per cent in Uttar Pradesh, Himachal
Pradesh and Maharashtra, to 5 per cent in Andhra Pradesh,
and 15 per cent in Kashmir and prevalence varies in same
region across tribes and caste. In India, the prevalence of
infertility problem ever experienced by currently married
women was 8.8%, of which 6.7%women had ever experienced
primary infertility and 2.1% women had ever experienced
secondary infertility. The prevalence of currently infertile
women was 4.6%.
IVF is probably the most widely practiced assisted
conception procedure in the world. Infertility treatment in
India is the treatment that is used to cure conditions of
infertility in patients or the medication provided to those
having problems bearing a child. The best IVF center in India is
Indira IVF hospital, India.

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29
 KARNATAKA:
As per details from Census 2011, Karnataka has
population of 6.11 Crores, an increase from figure of 5.29
Crore in 2001 census.
In 2018, fertility rate for Karnataka was 1.7 live
births per woman. Between 2007 and 2018, fertility rate of
Karnataka was declining at a moderating rate to shrink from
2.1 live births per woman in 2007 to 1.7 live births per woman
in 2018.
Two of the most common fertility treatments in Karnataka :
• 1. Intrauterine insemination (IUI) Healthy sperm is collected
and inserted directly into your uterus when you're ovulating.
• 2. In vitro fertilization (IVF) Eggs are taken from your ovaries
and fertilized by sperm in a lab, where they develop into
embryos.

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6.Bibliography:
Websites:
1. https://www.who.int/reproductivehealth/topics/infertilit
y/recommendations_technical_experts.pdf
2. https://www.yourfertility.org.au/
3. https://www.who.int/reproductivehealth/topics/infertilit
y/en/
4. https://www.who.int/reproductivehealth/topics/infertilit
y/perspective/en/#:~:text=Infertility%20is%20defined%20
as%20a,in%20lower%20resource%20settings%20worldwi
de
5. https://www.betterhealth.vic.gov.au/health/ConditionsA
ndTreatments/infertility-in-women
6. https://www.mayoclinic.org/diseases-
conditions/infertility/symptoms-causes/syc-20354317
7. https://en.m.wikipedia.org/wiki/Infertility
8. https://www.researchgate.net/publication/319315704_In
fertility

TEDx Talks:
1. https://youtu.be/lQ548cTZ7tQ
2. https://youtu.be/6BBmMtVfZ4Y
3. https://youtu.be/RTr6kb9Ygeg

Books:
1. Bionengineering in Reproductive Medicine
2. Biology--NCERT’S
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