MAHALASHMI VIDHYA

MANDHIR AVADI

BIOLOGY INVESTIGATORY
PROJECT

INFERTILITY

SUBMITTED BY

R. KRITHIKA
XII A
11102
 ACKNOWLEDGEMENT
I am very glad to have the opportunity to make this
project & express my profound gratitude and deep
regards to my guide Mrs.Shobana for her
exemplary guidance, monitoring and constant
encouragement throughout this project. I would
like to thank the people who helped me directly or
indirectly to complete the project. I would also like
to extend my gratitude Principal Mrs. Beulah
Ebenezer , for their valuable encouragement and
approval of the project work. Lastly, I thank The
Almighty, my parents and friends for their constant
encouragement.

Internal Signature External Signature

Principal Signature
 CERTIFICATE
This project entitled “ INFERTILITY”, is the
investigatory project work in BIOLOGY,
successfully completed by Miss Krithika.R, student
of class – XII, MAHALASHMI VIDHYA MANDHIR
AVADI, under the supervision of Mrs.Shobana ,
for the partial fulfillment of requirements for
Central Board of Secondary Education leading to
the award of annual examination of the year 2022
- 2023

Internal Signature External Signature

Principal Signature
 CONTENT

S.No Topics
1. INTRODUCTION
2. TYPES OF INFERTILITY
3. THEORY
4. EFFECTS
5. SOCIAL IMPACT
6. CAUSES
7. TREATMENT
8. CONCLUSION
 INTRODUCTION

 A large number of couples all over the world

including India are infertile, i.e., they are
unable to produce children inspite of
unprotectedsexual co-habitation.
 The reasons for this could be many–physical,
congenital, diseases, drugs, immunological or
even psychological.
 In India, often the female is blamed for the
couple being childless, but more often than
not, the problem lies in the male partner.
 Specialised health care units (infertility
clinics, etc.) could help in diagnosis and
corrective treatment of some of these disorders
and enable these couples to have children
 TYPES OF INFERTILITY
There are 2 types of infertility:

 Primary infertility refers to couples who have not become

pregnant after at least 1 year having sex without using birth
control methods.

 Secondary infertility refers to couples who have been able to

get pregnant at least once, but now are unable.

PRIMARY INFERTILITY

 Primary infertility is when a pregnancy has never been

achieved by a person
CAUSES OF PRIMARY INFERTILITY
FEMALE
 Endometriosis
 uterine fibroids
 thyroid disease
MALE
 low sperm count or low testosterone

SECONDARY INFERTILITY
inability to conceive a child or carry a pregnancy to full term after
previously giving birth

CAUSES OF SECONDARY INFERTILITY

FEMALE
 Problems in the quantity or quality of eggs
 Problems with the fallopian tubes
 Endometriosis
MALE
 Reduced testosterone level
In humans, infertility may describe a woman who is
unable to conceive as well as being unable to carry a
pregnancy to full term. There are many biological
and other causes of infertility, including some that
medical intervention can treat. Infertility rates have
increased by 4% since the 1980s, mostly from
problems with fecundity due to an increase in age.
About 40% of the issues involved with infertility are
due to the man, another 40% due to the woman, and
20% result from complications with both partners.
Women who are fertile experience a natural period of
fertility before and during ovulation, and they are
naturally infertile during the rest of the menstrual
cycle. Fertility awareness methods are used to
discern when these changes occur by tracking
changes incervical mucus or basal body temperature
Infertility is “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 (and there is no other reason, such
as breastfeeding or postpartum amenorrhea).
Primary infertility is infertility in a couple who have
never had a child. Secondary infertility is failure to
conceive following a previous pregnancy. Infertility
may be caused by infection in the man or woman, but
often there is no obvious underlying cause.
One definition of infertility that is frequently used in
the United States by doctors who specialize in
infertility, to consider a couple eligible for treatment
is:
• a woman under 35 has not conceived after 12
months of contraceptive-free intercourse. Twelve
months is the lower reference limit for Time to
Pregnancy (TTP) by the World Health Organization.
• a woman over 35 has not conceived after 6 months
of contraceptive-free sexual intercourse
 Theory
Researchers commonly base demographic studies
on infertility prevalence on a five-year period.
Practical measurement problems, however, exist
for any definition, because it is difficult to measure
continuous exposure to the risk of pregnancy over
a period of years.
Primary vs. secondary infertility
Primary infertility is defined as the absence of a
live birth for women who desire a child and have
been in a union for at least five years, during
which they have not used any contraceptives. The
World Health Organization also adds that 'women
whose pregnancy spontaneously miscarries, or
whose pregnancy results in a still born child,
without ever having had a live birth would present
with primarily infertility
Secondary infertility is defined as the absence of a
live birth for women who desire a child and have
been in a union for at least five years since their
last live birth, during which they did not use any
contraceptives. Thus the distinguishing feature is
whether or not the couple have ever had a
pregnancy which led to a live birth
 EFFECTS
Psychological impact
The consequences of infertility are manifold and can include
societal repercussions and personal suffering. Advances in
assisted reproductive technologies, such as IVF, can offer
hope to many couples where treatment is available, although
barriers exist in terms of medical coverage and affordability.
The medicalization of infertility has unwittingly led to a
disregard for the emotional responses that couples experience,
which include distress, loss of control, stigmatization, and a
disruption in the developmental trajectory of adulthood.
Infertility may have profound psychological effects. Partners
may become more anxious to conceive, increasing sexual
dysfunction Marital discord often develops in infertile
couples, especially when they are under pressure to make
medical decisions. Women trying to conceive often have
clinical depression rates similar to women who have heart
disease or cancer. Even couples undertaking IVF face
considerable stress.
The emotional losses created by infertility include the denial
of motherhood as a rite of passage; the loss of one’s
anticipated and imagined life; feeling a loss of control over
one’s life; doubting one’s womanhood; changed and
sometimes lost friendships; and, for many, the loss of one’s
religious environment as a support system.
Emotional stress and marital difficulties are greater in
couples where the infertility lies with the man
 SOCIAL IMPACT

Infertility has significant negative social

impacts on the lives of infertile couples
and particularly women
 social stigma
 emotional stress
 depression
 anxiety
 low self-esteem
 Causes
Sexually transmitted disease
Infections with the following sexually transmitted pathogens
have a negative effect on fertility: Chlamydia trachomatis,
Neisseria gonorrhoeae, and Syphilis. There is a consistent
association of Mycoplasma genitalium infection and female
reproductive tract syndromes. M. genitalium infection is
associated with increased risk of infertility.
Genetic
A Robertsonian translocation in either partner may cause
recurrent spontaneous abortions or complete infertility.
Other causes
Factors that can cause male as well as female infertility are:
• DNA damage
• DNA damage reduces fertility in female ovocytes, as caused
by smoking,other xenobiotic DNA damaging agents (such as
radiation or chemotherapy)or accumulation of the oxidative
DNA damage 8-hydroxy-deoxyguanosine
• DNA damage reduces fertility in male sperm, as caused by
oxidative DNA damage,smoking,other xenobiotic DNA
damaging agents (such as drugs or chemotherapy)or other
DNA damaging agents including reactive oxygen species,
fever or high testicular temperature
• General factors
• Diabetes mellitus, thyroid disorders,undiagnosed and
untreated coeliac disease adrenal disease
• Hypothalamic-pituitary factors
• Hyperprolactinemia
• Hypopituitarism
• The presence of anti-thyroid antibodies is associated
with an increased risk of unexplained subfertility with
an odds ratio of 1.5 and 95% confidence interval of
1.1–2.0
• Environmental factors
• Toxins such as glues, volatile organic solvents or
silicones, physical agents, chemical dusts, and
pesticides Tobacco smokers are 60% more likely to be
infertile than non-smokers.
German scientists have reported that a virus called
Adeno-associated virus might have a role in male
infertility, though it is otherwise not harmful. Other
diseases such aschlamydia, and gonorrhea can also
cause infertility, due to internal scarring (fallopian tube
obstruction).
Females
The following causes of infertility may only be found in
females. For a woman to conceive, certain things have
to happen: intercourse must take place around the time
when an egg is released from her ovary; the system that
produces eggs has to be working at optimum levels; and
her hormones must be balanced.
For women, problems with fertilisation arise mainly
from either structural problems in the Fallopian tube or
uterus or problems releasing eggs. Infertility may be
caused by blockage of the Fallopian tube due to
malformations, infections such as Chlamydia and/or
scar tissue. For example, endometriosis can cause
infertility with the growth of endometrial tissue in the
Fallopian tubes and/or around the ovaries.
Endometriosis is usually more common in women in
their mid-twenties and older, especially when
postponed childbirth has taken place.
Another major cause of infertility in women may be the
inability to ovulate. Malformation of the eggs
themselves may complicate conception. For example,
polycystic ovarian syndrome is when the eggs only
partially developed within the ovary and there is an
excess of male hormones. Some women are infertile
because their ovaries do not mature and release eggs.
In this case synthetic FSH by injection or Clomid
(Clomiphene citrate) via a pill can be given to stimulate
follicles to mature in the ovaries.
Other factors that can affect a woman's chances of
conceiving include being overweight or underweight, or
her age as female fertility declines after the age of 30.
Sometimes it can be a combination of factors, and
sometimes a clear cause is never established.
Common causes of infertility of females include:
• Ovulation problems (e.g. polycystic ovarian syndrome,
PCOS, the leading reason why women present to fertility
clinics due to anovulatory infertility)
• tubal blockage
• pelvic inflammatory disease caused by infections like
tuberculosis
• age-related factors
• uterine problems
• previous tubal ligation
• endometriosis
• advanced maternal age
Male
The main cause of male infertility is low semen
quality. In men who have the necessary
reproductive organs to procreate, infertility can
be caused by low sperm count due to endocrine
problems, drugs, radiation, or infection. There
may be testicular malformations, hormone
imbalance, or blockage of the man's duct system.
Although many of these can be treated through
surgery or hormonal substitutions, some may be
indefinite. Infertility associated with viable, but
immotile sperm may be caused by primary ciliary
dyskinesia
Combined infertility
In some cases, both the man and woman may be
infertile or sub-fertile, and the couple's infertility
arises from the combination of these conditions.
In other cases, the cause is suspected to be
immunological or genetic; it may be that each
partner is independently fertile but the couple
cannot conceive together without assistance.
 Unexplained infertility

 Unexplained infertility is the default diagnosis

when evaluations of an infertile couple or person
find no specific cause of the infertility and show
that the woman’s fallopian tubes and ovulation are
normal and the man has healthy sperm.
unexplained infertility.In these cases abnormalities
are likely to be present but not detected by current
methods. Possible problems could be that the egg
is not released at the optimum time for
fertilization, which it may not enter the fallopian
tube, sperm may not be able to reach the egg,
fertilization may fail to occur, transport of the
zygote may be disturbed, or implantation fails. It is
increasingly recognized that egg quality is of
critical importance and women of advanced
maternal age have eggs of reduced capacity for
normal and successful fertilization. Also,
polymorphisms in folate pathway genes could be
one reason for fertility complications in some
women with unexplained infertility.

GENERAL CAUSES OF INFERTILITY

GENERAL CAUSES OF INFERTILITY
GENERAL CAUSES OF INFERTILITY
 TREATMENT

Assisted reproductive technologies (ART)

1. In vitro fertilization (IVF)

2. zygote intra fallopian transfer(ZIFT)

3. Intra uterine transfer(IUT)

4. Gamete intra fallopian transfer(GIFT)

5. Intra cytoplasmic sperm injection(ICSI)

6. Intra-uterine insemination(IUI)

– Infertility treatments for women in India include

IVF, ICSI, medication to restore hormonal
balance, GIFT, ZIFT, and more.
– The various infertility treatments for men in
India include rectal probe electroejaculation, anti-
estrogen medication and gonadotropin
therapy.There are some homeopathic treatments
for infertility in males that one can explore as well.
Assisted reproductive technologies (ART)

Assisted reproductive technology (ART) is used to

treat infertility. It includes fertility treatments that
handle both eggs and sperm. It works by removing
eggs from the ovaries. The eggs are then mixed
with sperm to make embryos. The embryos are
then put back in the parent's body. In vitro
fertilization (IVF) is the most common and
effective type of ART.
ART procedures sometimes use donor eggs, donor
sperm, or previously frozen embryos. It may also
involve a surrogate or gestational carrier. A
surrogate is a person who becomes pregnant with
sperm from one partner of the couple. A
gestational carrier becomes pregnant with an egg
from one partner and sperm from the other
partner.

The most common complication of ART is

a multiple pregnancy. It can be prevented or
minimized by limiting the number of embryos that
are put into the parent's body.
 In vitro fertilization (IVF)

In vitro fertilization (IVF) is the joining of a woman's

egg and a man's sperm in a laboratory dish. In vitro
means outside the body. Fertilization means the sperm
has attached to and entered the egg.

Normally, an egg and sperm are fertilized inside a

woman's body. If the fertilized egg attaches to the lining
of the womb and continues to grow, a baby is born
about 9 months later. This process is called natural or
unassisted conception.

IVF is a form of assisted reproductive technology

(ART). This means special medical techniques are used
to help a woman become pregnant. It is most often tried
when other, less expensive fertility techniques have
failed

There are five basic steps to IVF:

Step 1: Stimulation, also called super ovulation

 Medicines, called fertility drugs, are given to the

woman to boost egg production.
 Normally, a woman produces one egg per month.
Fertility drugs tell the ovaries to produce several eggs.
 During this step, the woman will have
regular transvaginal ultrasounds to examine the ovaries
and blood tests to check hormone levels.
Step 2: Egg retrieval

 A minor surgery, called follicular aspiration, is

done to remove the eggs from the woman's body.
 The surgery is done in the doctor's office most of
the time. The woman will be given medicines so she
does not feel pain during the procedure. Using
ultrasound images as a guide, the health care provider
inserts a thin needle through the vagina into the ovary
and sacs (follicles) containing the eggs. The needle is
connected to a suction device, which pulls the eggs and
fluid out of each follicle, one at a time.
 The procedure is repeated for the other ovary.
There may be some cramping after the procedure, but it
will go away within a day.
 In rare cases, a pelvic laparoscopy may be needed
to remove the eggs. If a woman does not or cannot
produce any eggs, donated eggs may be used.


Step 3: Insemination and Fertilization

 The man's sperm is placed together with the best

quality eggs. The mixing of the sperm and egg is called
insemination.
 Eggs and sperm are then stored in an
environmentally controlled chamber. The sperm most

 often enters (fertilizes) an egg a few hours after
insemination.
 If the doctor thinks the chance of fertilization is
low, the sperm may be directly injected into the egg.
This is called intracytoplasmic sperm injection (ICSI).
 Many fertility programs routinely do ICSI on some
of the eggs, even if things appear normal.
Step 4: Embryo culture

 When the fertilized egg divides, it becomes an

embryo. Laboratory staff will regularly check the
embryo to make sure it is growing properly. Within
about 5 days, a normal embryo has several cells that
are actively dividing.
 Couples who have a high risk of passing a genetic
(hereditary) disorder to a child may consider pre-
implantation genetic diagnosis (PGD). The procedure
is most often done 3 to 5 days after fertilization.
Laboratory scientists remove a single cell or cells from
each embryo and screen the material for specific
genetic disorders.
 According to the American Society for
Reproductive Medicine, PGD can help parents decide
which embryos to implant. This decreases the chance of
passing a disorder onto a child. The technique is
controversial and not offered at all centers.
Step 5: Embryo transfer
 Embryos are placed into the woman's womb 3 to 5
days after egg retrieval and fertilization.
 The procedure is done in the doctor's office while
the woman is awake. The doctor inserts a thin tube
(catheter) containing the embryos into the woman's
vagina, through the cervix, and up into the womb. If an
embryo sticks to (implants) in the lining of the womb
and grows, pregnancy results.
 More than one embryo may be placed into the
womb at the same time, which can lead to twins,
triplets, or more. The exact number of embryos
transferred is a complex issue that depends on many
factors, especially the woman's age.
 Unused embryos may be frozen and implanted or
donated at a later date
IVF IN VITRO FERTILIZATION
Intra uterine transfer(IUT)

Intrauterine insemination (IUI) — a type of artificial

insemination — is a procedure for treating infertility.

Intrauterine Insemination
IUI, Intrauterine insemination, is a relatively simple treatment
that increases the number of sperm cellsplaced in the uterus.
IUI procedures involve the washing and separating of a
semen sample from seminal fluid. This is then inserted directly
into the uterus with a thin catheter. Women have stated that
IUI injections are usually painless while some women
reported mild discomfort. The IUI fertility
treatment procedure can be IUI procedures involve the
washing and separating of a semen sample from seminal fluid.
This is then inserted directly into the uterus with a thin
catheter. Women have stated that IUI injections are usually
painless while some women reported mild discomfort.
The IUI fertility treatment procedure can be performed with
a male partner’s sperm or with a donor’s sperm.performed
with a male partner’s sperm or with a donor’s sperm.
IUI fertility treatment in India is less expensive than IVF
treatments. IUI treatments cost anywhere between Rs.4500 to
Rs. 5000 in India for a single cycle. Studies have revealed that
IUI inseminations are relatively safe and do not seem to
increase the risk of birth and developmental defects in your
baby. An IUI baby will in most cases be as healthy as a
naturally conceived baby or one from an IVF procedure. IUI
success rates depends on the number of IUI cycles for
example, women have about a 15% chance of
conceiving on one cycle of IUI but 80% chance after 6
or 7 cycles. IUI procedures are used in the following
cases:
Unexplained infertility
Low sperm count
Multiple failed attempts to improve sperm motility
Issues with ejaculation or erection
Issues with the cervix or cervical mucus
Mild endometriosis
A single woman wishing to get pregnant or a couple not
wanting to pass on a genetic defect from the male
partner may seek IUI fertility treatment
 ICSI (Intracytoplasmic Sperm Injection)

ICSI infertility treatment involves the injection of a

single sperm directly into a mature egg with the help of
a tiny needle, called a micropipette. Once fertilised, the
egg (an embryo at this stage) grows in a laboratory for
1-5 days before being transferred to the woman’s
uterus.
ICSI is performed simultaneously
with IVF. ICSI infertility treatment is commonly used in
cases of severe male infertility. Some of these factors
include low sperm count, poor sperm motility, the
decreased ability of sperm cells to penetrate the egg, or
a previous unsuccessful IVF procedure.
Egg Donation
Donor eggs, sometimes also referred to as donor
embryos, allow an infertile woman to conceive a child.
The process of a fertility egg donation involves the
retrieval of eggs from a woman with normally
functioning ovaries. Later, the eggs are fertilised in
the IVF lab. The process may either use the sperm of
the partner or a donor.
GIFT and ZIFT

GIFT and ZIFT are modified versions of the IVF. In Zygote

Intrafallopian Transfer (ZIFT), another infertility treatment in
India where doctors place the fertilised eggs, which are
zygotes at this stage, into the fallopian tubes within 24 hours.
In Gamete Intrafallopian Tube Transfer (GIFT), the sperm
and eggs are mixed before a doctor inserts them, with the
hope that one of the eggs fertilized inside the fallopian tubes.
In ZIFT, the eggs are placed in the fallopian tubes instead of
directly placing them in the uterus. In contrast, with GIFT,
fertilization takes place in the body rather than in a petri dish.
In traditional IVF, the embryos are incubated and raised in a
laboratory for 3 to 5 days. In comparison, GIFT and ZIFT are
quicker.
 Bibliography

www.google.com
www.wikipedia.com
www.who.com
www.medlineplus.gov