INVESTIGATORY PROJECT ON

INFERTILITY
SUBMITTED TO

CENTRAL BOARD OF SECONDARY EDUCATION

NEW DELHI

ACADEMIC YEAR 2023-24

BY
ASHOKAN. V
UNDER THE GUIDANCE OF

Mr. Srinivasan P.S, M.Sc, B.Ed, D.Ted

BIOLOGY DEPARTMENT

Senthil Public School, Dharmapuri.

Montessori & CBSE Stream
(Affiliated to CBSE, New Delhi, Affiliation No.: 1930752)
 ACKNOWLEDGEMENT

I am here overwhelmed in all humbleness and gratefulness to acknowledge

my depth to all those who have helped me to put these ideas well above
the level of simplicity.

I would like to express my special note of gratitude to my teacher

Mr. Srinivasan P.S, M.Sc, B.Ed, D.Ted, for spending many precious hours
in helping me for the quality of this, kindly providing valuable guidance,
motivation and his encouragement.

I would like to thank our Senior Principal Sri. Srinivasan. C M.Sc.,

M.Ed., Dip. in Montessori, and our Principal Sri. Senthil Murugan. P,
M.Sc., B.Ed., G.NIIT., our Vice Principal Sri. Rajkumar. S. M.Sc.,
B.Ed., M. Phil., and our Academic Coordinator Srimathi. Gnana
Kavitha. M. M.Sc., B.Ed., who gave me this golden opportunity to do this
wonderful project. It also helped me in doing a lot of research and I came
to know about many new things. I am really thankful to my lab in charge
Ms. Sumathra N, M.A., B.Ed., M.Sc., D.TEd.,

I would like to thank my parents who helped me a lot in gathering

information, collecting data and guiding me from time to time in making
this project, despite of their busy schedule. They gave me different ideas in
making this project unique.
-ASHOKAN.V
 CONTENTS
SNO TOPIC PAGE
NO
1 UNDERSTANDING INFERTILITY 4

2 MEDICAL EVALUATION FOR INFERTILITY 5

3 LIFESTYLE FACTORS AFFECTING FERTILITY 7

4 MALE FACTOR INFERTILITY 9

5 FEMALE FACTOR INFERTILITY 10

6 INTRAUTERINE INSEMINATION (IUI) 11

7 IN VITRO FERTILIZATION (IVF) 12

8 DONOR GAMETE AND SURROGACY OPTIONS 14

9 PRE-IMPLANTATION GENETIC TESTING (PGT): 16

INDICATIONS AND LIMITATIONS
10 LEGAL AND ETHICAL CONSIDERATIONS IN ASSISTED 18
REPRODUCTION
11 FUTURE DIRECTIONS IN FERTILITY TREATMENT AND 20
RESEARCH
12 DISCUSSION 22
13 BIBLIOGRAPHY 23

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UNDERSTANDING INFERTILITY

Infertility is a condition that affects both men and women, and is defined as the
inability to conceive a child despite regular, unprotected sexual intercourse for a
period of one year or more. In some cases, infertility can be temporary and may be
overcome with treatment, while in other cases, it may be permanent.

There are several factors that can contribute to infertility, including age, hormonal
imbalances, structural abnormalities, infections, lifestyle factors such as smoking
and alcohol consumption, and genetic factors. In men, infertility can be caused by
low sperm count, poor sperm motility or morphology, or other problems with the
male reproductive system. In women, infertility can be caused by problems with
ovulation, blocked or damaged fallopian tubes, endometriosis, or other issues
affecting the reproductive system.

Diagnosis of infertility typically involves a thorough medical history, physical

examination, and various tests, including blood tests to measure hormone levels,
semen analysis for men, and imaging tests such as ultrasound to evaluate the
reproductive organs. In some cases, more invasive tests such as laparoscopy or
hysteroscopy may be required to further evaluate the reproductive organs.

Treatment options for infertility depend on the underlying cause and may include
medications to stimulate ovulation or improve sperm quality, surgical procedures
to correct structural abnormalities or blockages, intrauterine insemination (IUI) or
in vitro fertilization (IVF), and assisted reproductive technologies such as donor
sperm or eggs, and surrogacy.

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MEDICAL EVALUATION FOR INFERTILITY

Infertility is a common problem affecting many couples worldwide. If you and

your partner have been trying to conceive for over a year without success, it is
recommended that you undergo a medical evaluation to determine the cause of
your infertility.

Here are some common steps in the medical evaluation for infertility:

1. Medical history: Your doctor will ask you and your partner about your medical
history, including any past surgeries or medical conditions that may affect fertility.

2. Physical exam: A physical exam may be performed to assess for any

abnormalities or signs of infertility.

3. Semen analysis: A semen analysis is used to assess the quality and quantity of
sperm in your partner's semen.

4. Ovulation assessment: Your doctor may use a variety of methods to assess if you
are ovulating regularly, including blood tests to measure hormone levels,
ultrasound to visualize the ovaries, and tracking changes in basal body
temperature.

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5. Imaging studies: Imaging studies such as ultrasound, hysterosalpingogram
(HSG), and laparoscopy may be used to assess the reproductive organs and identify
any abnormalities.

6. Genetic testing: Your doctor may recommend genetic testing if there is a

suspicion of a genetic cause of infertility.

7. Hormone testing: Hormone testing may be used to evaluate for any hormonal
imbalances that could be contributing to infertility.

Based on the results of these tests, your doctor may recommend various treatment
options, including medication, surgery, or assisted reproductive technologies such
as in vitro fertilization (IVF) or intrauterine insemination (IUI).

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LIFESTYLE FACTORS AFFECTING FERTILITY

There are several lifestyle factors that can affect fertility, both in men and women.
Here are some of the most common ones:

1. Age: As women get older, their fertility declines, and the quality of their eggs
decreases. Men also experience a decline in fertility as they age, but it is usually
not as significant as in women.

2. Weight: Both being overweight and underweight can affect fertility. Obesity can
lead to hormonal imbalances, insulin resistance, and other health issues that can
interfere with fertility. On the other hand, being underweight can disrupt ovulation
and affect hormone production.

3. Exercise: Moderate exercise can improve fertility, but excessive exercise can
have the opposite effect. Overexertion can lead to irregular menstrual cycles and
affect hormone production, which can make it more difficult to conceive.

4. Smoking: Smoking can significantly reduce fertility in both men and women. It
can damage eggs and sperm and reduce the number of viable sperm, making it
more difficult to conceive.

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5. Alcohol and drug use: Excessive alcohol consumption and drug use can have
negative effects on fertility. They can disrupt hormone production and reduce
sperm count and motility.

6. Stress: Chronic stress can disrupt ovulation and affect hormone production,
making it more difficult to conceive. It can also reduce sex drive, which can make
it harder to get pregnant.

7. Diet: A healthy diet that is rich in fruits, vegetables, and whole grains can
improve fertility. On the other hand, a diet that is high in processed foods and
saturated fats can negatively affect fertility.

Overall, maintaining a healthy lifestyle that includes a balanced diet, regular

exercise, and avoiding harmful habits like smoking and excessive alcohol
consumption can help improve fertility.

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MALE FACTOR INFERTILITY

Male factor infertility refers to the inability of a man to impregnate a female

partner due to issues with his reproductive system. Male factor infertility can be
caused by a variety of factors, including low sperm count, poor sperm motility,
abnormal sperm morphology, and blockages or damage to the male reproductive
tract.

Some common causes of male factor infertility include:

1. Varicocele - a condition where the veins in the scrotum become enlarged and
heat up the testicles, affecting sperm production.

2. Hormonal imbalances - imbalances in hormones such as testosterone and

luteinizing hormone (LH) can affect sperm production and motility.

3. Infections - sexually transmitted infections (STIs) can cause inflammation of the

testicles or epididymis, which can lead to infertility.

4. Genetic factors - certain genetic abnormalities can cause male infertility.

5. Lifestyle factors - factors such as smoking, alcohol consumption, drug use, and
obesity can all have negative impacts on sperm production and quality.

Treatment options for male factor infertility depend on the specific cause of the
condition. Treatments can range from lifestyle changes to medical interventions
such as surgery or assisted reproductive technologies such as in vitro fertilization
(IVF) or intracytoplasmic sperm injection (ICSI).

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FEMALE FACTOR INFERTILITY

Female factor infertility refers to infertility that is caused by factors related to the
female reproductive system. This can include problems with ovulation, fallopian
tube blockages or damage, uterine abnormalities, endometriosis, polycystic ovary
syndrome (PCOS), and age-related infertility.

Some of the common causes of female factor infertility are:

1. Ovulation disorders: Irregular ovulation or failure to ovulate can be caused by

hormonal imbalances, thyroid problems, or PCOS.

2. Fallopian tube blockage or damage: This can be caused by pelvic inflammatory

disease, endometriosis, or previous surgeries.

3. Uterine abnormalities: Uterine fibroids, polyps, or structural abnormalities can

interfere with implantation of a fertilized egg.

4. Endometriosis: This condition can cause scarring and adhesions in the

reproductive organs, interfering with ovulation, fertilization, and implantation.

5. Age-related infertility: As women age, the quality and quantity of their eggs
decline, making it harder to conceive.

Treatment for female factor infertility will depend on the underlying cause. In
some cases, fertility medications or surgery may be used to correct the problem. In
other cases, assisted reproductive technologies such as in vitro fertilization (IVF)
may be necessary. It is important to consult with a fertility specialist to determine
the best course of treatment.

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INTRAUTERINE INSEMINATION (IUI)

Intrauterine insemination (IUI) is a fertility treatment that involves placing washed

and concentrated sperm directly into a woman's uterus. The goal of IUI is to
increase the number of sperm that reach the fallopian tubes and increase the chance
of fertilization.

IUI is often used in cases where there is unexplained infertility or mild male factor
infertility. It may also be used in combination with fertility drugs to stimulate
ovulation.

The IUI procedure typically involves the following steps:

1. Ovulation Induction: The woman is given fertility drugs to stimulate the ovaries
to produce multiple eggs.

2. Sperm Collection: The male partner provides a semen sample, which is then
washed and concentrated to separate the healthy sperm from the seminal fluid.

3. Insemination: The concentrated sperm is then inserted into the woman's uterus
using a thin catheter.

The procedure itself is usually painless and takes only a few minutes to complete.
After the procedure, the woman may be advised to lie down for a short time to
increase the chance of successful fertilization.

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IN VITRO FERTILIZATION (IVF)

In vitro fertilization (IVF) is a type of assisted reproductive technology (ART) that

involves fertilizing an egg with sperm outside of the body, in a laboratory dish.
The resulting embryos are then transferred to the uterus in the hopes of establishing
a successful pregnancy.The process of IVF typically involves several steps,
including:

1. Ovarian stimulation: Medications are given to the woman to stimulate the

ovaries to produce multiple eggs.

2. Egg retrieval: Once the eggs have matured, they are retrieved from the woman's
ovaries using a needle inserted through the vagina.

3. Fertilization: The retrieved eggs are then fertilized in the laboratory with sperm,
either from the woman's partner or from a donor.

4. Embryo culture: The resulting embryos are cultured in the laboratory for several
days until they reach a certain stage of development.

5. Embryo transfer: One or more embryos are transferred to the woman's uterus
using a catheter, with the hope of implantation and successful pregnancy.

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IVF is typically used in cases of infertility caused by factors such as blocked
fallopian tubes, male factor infertility, or unexplained infertility. It can also be used
in cases where other fertility treatments have failed.

While IVF can be a highly effective way to conceive a child, it is also a complex
and expensive procedure that carries some risks, including multiple pregnancies
and ovarian hyper stimulation syndrome (OHSS). It's important to discuss the risks
and benefits of IVF with a qualified healthcare provider before deciding whether
it's the right choice for you.

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DONOR GAMETE AND SURROGACY OPTIONS

Donor gamete and surrogacy options are methods used to help people who are
struggling with infertility or who are unable to conceive a child naturally. Donor
gamete options involve using eggs, sperm, or embryos donated by individuals to
help someone else conceive. Surrogacy involves using a woman who carries a
pregnancy for another person or couple.

There are different types of donor gamete options, including:

1. Egg donation: In this process, a woman donates her eggs to another woman who
is unable to produce her own eggs or has poor-quality eggs. The donated eggs are
then fertilized with sperm in a lab and the resulting embryos are transferred to the
recipient's uterus.

2. Sperm donation: In this process, a man donates his sperm to another person or
couple who is unable to conceive naturally. The donated sperm is then used to
fertilize the recipient's eggs either through intrauterine insemination (IUI) or in
vitro fertilization (IVF).

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3. Embryo donation: In this process, couples who have undergone IVF treatment
and have extra embryos can donate them to others who are unable to conceive
naturally. The donated embryos are transferred to the recipient's uterus.

Surrogacy options include:

1. Traditional surrogacy: In this process, the surrogate uses her own eggs and is
inseminated with the intended father's sperm. The resulting child is genetically
related to the surrogate.

2. Gestational surrogacy: In this process, the surrogate carries a child conceived

using the eggs and sperm of the intended parents or donors. The surrogate is not
genetically related to the child.

It's important to note that the laws regarding donor gamete and surrogacy options
vary by country and even by state/province within a country. It's important to seek
legal and medical advice before pursuing any of these options.

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PRE-IMPLANTATION GENETIC TESTING (PGT):
INDICATIONS AND LIMITATIONS

Pre-implantation Genetic Testing (PGT) is a technique used to test embryos for

genetic disorders before implantation. This process involves removing a few cells
from a developing embryo and analyzing them for any genetic abnormalities. PGT
has become increasingly popular over the years, as it allows prospective parents to
reduce the risk of passing genetic disorders to their children.

Indications:

1. Genetic Disorders: PGT is recommended for couples who have a family history
of genetic disorders or who are carriers of genetic mutations that increase the risk
of genetic disorders in their offspring.

2. Recurrent Pregnancy Loss: PGT can be useful for couples who have experienced
recurrent pregnancy loss or have had multiple failed IVF cycles. PGT can help
identify any chromosomal abnormalities in the embryos that may be causing these
issues.

3. Advanced Maternal Age: Women who are older than 35 years have a higher risk
of producing eggs with chromosomal abnormalities. PGT can help detect such
abnormalities and increase the chances of a successful pregnancy.

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Limitations:

1. False Negatives: PGT may not detect all genetic abnormalities in the embryos,
leading to false negatives. This can result in the transfer of an abnormal embryo
and may increase the risk of having a child with a genetic disorder.

2. False Positives: PGT can also produce false positives, which can lead to the
unnecessary discarding of healthy embryos.

3. Cost: PGT is an expensive procedure, and the cost can vary depending on the
number of embryos being tested and the type of testing being used.

4. Ethical Concerns: There are ethical concerns surrounding PGT, as it involves

selecting which embryos to implant based on their genetic makeup. This raises
questions about what traits are desirable and whether this technology could be used
to create "designer babies."

5. Invasive Procedure: PGT requires the removal of a few cells from the embryo,
which can potentially harm the embryo and reduce its chances of survival.

Overall, PGT can be a useful tool for couples who are at risk of passing on genetic
disorders to their children. However, it is important to consider its limitations and
potential ethical concerns before undergoing the procedure.

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LEGAL AND ETHICAL CONSIDERATIONS IN
ASSISTED REPRODUCTION

Assisted reproduction, also known as assisted reproductive technology (ART),

refers to any medical procedure that helps couples or individuals have a baby.
There are several legal and ethical considerations associated with assisted
reproduction that must be taken into account.

Legal Considerations:

1. Parental rights: In cases where donor sperm, eggs, or embryos are used, the issue
of parental rights can become complicated. Laws regarding parental rights vary by
state and country.

2. Surrogacy agreements: Surrogacy arrangements should be legally binding, and

both parties should be fully informed of their rights and responsibilities.

3. Ownership of embryos: In cases where embryos are created but not all of them
are used, the issue of ownership must be addressed. Laws regarding ownership of
embryos vary by state and country.

4. Regulation of ART clinics: In many countries, ART clinics must be licensed and
regulated to ensure that they meet certain standards of safety and efficacy.

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Ethical Considerations:

1. Informed consent: Patients should be fully informed of the risks and benefits of
ART procedures before consenting to them.

2. Donor anonymity: The use of anonymous sperm or egg donors raises ethical
concerns about the rights of children to know their genetic origins.

3. Multiple pregnancies: ART procedures often result in multiple pregnancies,

which can increase the risk of complications for both the mother and the babies.

4. Selection of embryos: In cases where multiple embryos are created, the issue of
selecting which one to use raises ethical concerns about the potential for selecting
embryos based on certain traits or characteristics.

5. Access and affordability: Access to ART procedures can be limited by factors

such as cost and geographic location, which raises ethical concerns about equity
and justice.

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FUTURE DIRECTIONS IN FERTILITY
TREATMENT AND RESEARCH

Fertility treatment and research have advanced significantly in recent years, and
there are several promising directions for the future. Here are a few examples:

1. Gene editing: CRISPR-Cas9 technology has opened up new possibilities for

editing genes associated with infertility. For example, scientists have used this
technique to correct genetic mutations associated with male infertility in mice.
While this technology is still in its early stages, it holds great promise for treating
genetic causes of infertility in humans.

2. In vitro gametogenesis (IVG): This technique involves creating eggs or sperm

from stem cells in the lab. IVG could potentially be used to treat infertility caused
by premature ovarian failure, chemotherapy, or other conditions that damage
reproductive tissues. While this technology is still in the experimental stage, it
could offer hope to many couples struggling with infertility.

3. Artificial wombs: Researchers are working on developing artificial wombs that

could potentially allow for gestation outside the body. This technology could be
used to treat infertility caused by conditions such as uterine factor infertility or to
provide a safer alternative to traditional surrogacy.

4. Improvements in embryo selection: Advances in artificial intelligence and

machine learning are enabling researchers to develop algorithms that can predict

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which embryos are most likely to result in a successful pregnancy. This could help
increase the success rates of in vitro fertilization (IVF) and reduce the number of
embryos that need to be transferred.

5. Fertility preservation: There is growing interest in developing new ways to

preserve fertility, such as freezing ovarian tissue, eggs, or sperm. These techniques
could help women and men who face infertility due to cancer treatment, for
example, or those who wish to delay parenthood for personal or medical reasons.

Overall, there is reason for optimism when it comes to the future of fertility
treatment and research. With continued advancements in technology and a growing
understanding of the underlying biology of infertility, we may soon be able to offer
hope to many couples who have struggled to conceive.

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DISCUSSION

Infertility is a complex and often emotionally challenging condition that affects

many individuals and couples. While there are a variety of factors that can
contribute to infertility, including medical, lifestyle, and environmental factors,
many cases can be successfully treated with medical interventions or assisted
reproductive technologies such as IVF.

It is important for individuals and couples who are experiencing infertility to seek
the help of a qualified healthcare professional, who can provide a comprehensive
evaluation and recommend appropriate treatment options. Additionally, seeking
support from family, friends, or a mental health professional can be helpful in
coping with the emotional aspects of infertility.

Ultimately, infertility is a difficult and often frustrating condition, but with the
right support and treatment, many individuals and couples are able to successfully
achieve pregnancy and build the families they desire.

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BIBLIOGRAPHY

1. https://www.who.int/news-room/fact-sheets/detail/infertility
2. https://www.cdc.gov/reproductivehealth/infertility
3. https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility
4. https://www.nichd.nih.gov/health/topics/infertility
5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/male-infertility
6. NCERT Textbook class 12 Biology
7. Collins ICSE Biology class 8

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