VEER NARMAD SOUTH GUUJARAT UNIVERSITY, SURAT

Department of Biosciences
Ph. D. Course Work 2022-23
Assignment Submission
Ph. D Registration number: 1785
Name: Patel ShitalKumari Arvindbhai
Subject: CW 103ZO: Advances in Zoology
Topic Name: Unit: 1 (1.2) Reproductive Disorders & Advanced
techniques IVF
Date: 25/12/2023
Signature: _________
Reproductive disorders encompass a wide range of conditions that affect the
reproductive system in both males and females, leading to difficulties in
conceiving or maintaining a pregnancy. These disorders can result from various
factors, including genetic, hormonal, structural, or environmental issues. Here are
some common reproductive disorders:
1. Pregnancy disorders: The pattern of disease has changed with
improvements in socio-economic conditions. For example, the incidence
of antenatal anaemia has decreased progressively in the past few decades
1, 2 and pulmonary tuberculosis, which used to be prevalent, is now seen
only rarely. Chronic rheumatic heart disease has also become less common.
On the other hand, gestational diabetes has become more common. This
may be due partly to the setting up of screening services for gestational
diabetes in many hospitals. According to the territory wide audit report on
obstetrics and gynaecology, published by the Hong Kong College of
Obstetricians and Gynaecologists, the four most common medical
disorders complicating pregnancy are anaemia, diabetes mellitus, cardiac
disease, and thyroid disease which occur in 6.3%, 3.0%, 0.7%, and 0.6%
of pregnant women, respectively. In addition, because of the improvements
in the medical, obstetric, and anaesthetic management of pregnancy, many
women with medical disorders can go through a pregnancy without major
problems. The maternal mortality rate in Hong Kong (expressed per 100
000 total births) has dropped from 45 in 1961 to 4 in 1990.4 The most
common cause of maternal mortality is an amniotic fluid embolism.3
Maternal mortality is now rarely due to medical disorders and there are
very few medical indications for termination of pregnancy. There has also
been a progressive decrease in the perinatal mortality associated with some
medical disorders such as diabetes.1,2 It is important for all health care
professionals involved in the management of pregnant women with
medical disorders to be conversant with the latest developments in order to
provide the best care for these women. The four articles in this issue are
certainly helpful in this respect.5-8 There are four important clinical
principles in the management of women with medical disorders.9,10
Firstly, medical disorders are affected by pregnancy, when important
physiological changes occur in almost every system in the body.
Haemodynamic changes may lead to an additional burden on the
cardiovascular Medical disorders in pregnancy system, which may
predispose to the occurrence of heart failure in women with cardiac disease
or hypertension. The diabetogenic effects of hormonal changes during
pregnancy may lead to the development of gestational diabetes 5 and they
also make the control of pre-existing diabetes more difficult. Secondly,
medical disorders may affect the pregnancy. Diabetes may lead to foetal
macrosomia 5 while chronic hypertension or renal disease can result in
foetal growth retardation. Thirdly, physiological changes during pregnancy
make the diagnosis of a medical disorder more difficult. Sometimes
abnormal symptoms due to medical disorders may be attributed to the
pregnancy, leading to a delay in diagnosis, while physiological symptoms
and signs may lead to overdiagnosis of some medical disorders. Finally,
the treatment of medical disorders during pregnancy may be different from
their treatment in the non-pregnant state. In a pregnant woman, there are
two patients—the mother and the foetus. The physician and the obstetrician
have to balance the risks and benefits to both the mother and foetus when
deciding on treatment. Proper counselling and preparation before a woman
becomes pregnant is important in ensuring the best outcome for the
pregnancy. The risk of a medical disorder and/or medical treatment to both
the mother and foetus should be explained to a woman before she becomes
pregnant so that an informed decision as to whether or not to get pregnant
can be made. Although rare nowadays, some medical disorders are
associated with a high mortality risk (over 25%).6 These women should be
advised against getting pregnant. It should be emphasised, however, that
the final decision should be made by the woman herself after proper
counselling. They should also be given proper advice about contraception
or sterilisation if they decide not to get pregnant. This will reduce the
chance of an unplanned pregnancy requiring termination. Some
contraceptive methods may not be entirely appropriate for women with
certain medical disorders and careful consideration should be given to the
efficacy and potential side effects, and to the medical condition of the
woman before the most suitable method is chosen. This may require
considerable skill and experience. Once the woman decides to embark on
a pregnancy, she should be properly prepared. Medication with possible
adverse effects on the foetus should be changed, if possible, to another
medication known to be safe in pregnancy. Since a woman is usually
pregnant for more than two weeks before the pregnancy can be diagnosed,
it is better to change the drug (especially if it is known to be teratogenic)
before the woman becomes pregnant. The medical condition should be
well controlled before attempting pregnancy. This may improve the foetal
outcome. In women with pre-existing diabetes, there is suggestive
evidence that good control of the diabetes will reduce the chance of foetal
anomalies. Proper preparation is also important to improve the maternal
outcome. For example, elective cardiac surgery may be necessary before
 pregnancy so that the condition of the woman can be improved. Again,
appropriate advice on contraception is necessary while the woman is
waiting for control of the medical condition. As prepregnancy counselling
requires the expertise of both the obstetrician and the physician, clinics
with the participation of both parties are ideal for the counselling and
treatment of these women. After the woman has conceived, the continued
cooperation of the obstetricians and physicians is necessary. In addition,
the involvement of other health care professionals may be required.
Anaesthesiologists should be consulted early for provision of the
appropriate method of pain control and the preparation for anaesthesia for
caesarean section either as an elective procedure or as an emergency during
labour. It is encouraging that anaesthesiologists in some hospitals (e.g.
Tsan Yuk Hospital) have started to run assessment clinics for antenatal
patients so that the patients can be prepared for the management of labour
and delivery. Surgeons may also need to be involved. In women with
medical conditions where the foetus may be affected, the neonatologist
should be consulted so that the baby can be given proper treatment
immediately after delivery. Physiotherapists, nursing staff, and other allied
health professionals can often contribute to the management of these
women. After delivery, the need for contraception should again be
discussed and the appropriate method advised. It cannot be emphasised too
much that the best management of a woman’s medical disorder requires a
multidisciplinary approach with good communication among all the staff
involved. In the management of more common medical disorders such as
diabetes or cardiac disease, a combined clinic with the participation of both
physicians and obstetricians is ideal. It may sometimes be necessary to hold
a case conference with all the health care professionals involved in the
treatment of the patient. It is only with the concerted effort of the specialties
involved that we can ensure an optimal outcome for pregnant women with
medical disorders.
2. Menstrual disorders: Menstrual disorder is a physical or emotional
problem that interferes with the normal menstrual cycle, causing pain,
unusually heavy or light bleeding, delayed menarche, or missed periods.
Classification of menstrual disorders:
1. Amenorrhea.
2. Dysmenorrhea (menstrual cramps).
3. Dysfunction uterine bleeding: The patterns of abnormal uterine
bleeding may be in the form of menorrhagia, hypomenorrhea,
oligomenorrhea, or Polymenorrhea.
1. Amenorrhea: Some women do not have heavy menstrual bleeding, but they
have the opposite problem no menstrual periods at all. This condition is called
amenorrhea, or the absence of menstruation. There are two classification of
amenorrhea according to the onset which divided into primary and secondary,
and according to the causes which divided into physiological and pathological.
(Coco, 1999) Classification according to the onset
1. Primary amenorrhea is diagnosed if the girl turns 16 yrs and hasn’t
menstruated. It’s usually caused by some problem in the endocrine system which
regulates the hormones. Sometimes these results from low body weight
associated with eating disorders, excessive exercise or medications. This medical
condition can be caused by a number of other things, such as a problem with the
ovaries or the hypothalamus or genetic abnormalities. Menstrual period should
being within 2 years of breast development, usually between ages 10 to 16 yrs.
2. Secondary amenorrhea is diagnosed if the woman had regular periods, but they
suddenly stop for three months or longer. It can be caused by problems that affect
estrogen levels including stress, weight loss, exercise or illness. Additionally,
problems affecting the pituitary gland =such as elevated levels of the hormone
prolactin or thyroid including hyperthyroidism or hypothyroidism= may cause
secondary amenorrhea. This condition can also occur if there is an ovarian cyst.
Classification according to the cause
1. Physiological amenorrhea: Normal or "Physiological" amenorrhea that is
occurs before puberty, during childbearing as pregnancy & lactation, and after
menopause.
2. Pathological amenorrhea which divided into:
1. False amenorrhea (cryptomenorrhea).
Definition Menstruation occurs but blood escape is prevented due to obstruction
(hidden menstruation).
Etiology: Congenital (absent vagina, transverse vaginal septum, imperforated
hymen & non communicating horn of uterus)
Ustrations of Hymen Types Acquired (cervical cautery, amputation and
conization & suturing anterior wall to posterior wall during C.S).
Pathology: Menstrual blood retained above the level of obstruction leading to
haematocolpos (blood retained in the vagina), hematomata (bleeding of or near
the uterus it can be caused by a proximal transverse vaginal septum),
haematosalpinx (bleeding into the fallopian tubes), & hemoperitoneum (the
presence of blood in the peritoneal cavity. the blood accumulates in the space
between the inner lining of the abdominal wall and the internal abdominal organs.
Signs and Symptoms: Amenorrhea, Lower abdominal cyclic pain (repeated every
month) Pelviabdominal swelling, distended vagina with blood leads to
compression on urethra, stretching retention of urine & difficulty in micturition.
Signs of cryptomenorrhea:
1. General examination: All secondary sexual characteristics are developed.
2. Abdominal examination: dull cystic pelviabdominal mass (haematocolpos).
3. Vaginal examination: Bulging bluish distend e d hymen indicates imperforated
hymen.
4. Per rectum examination (PIR): cystic swelling felt in front rectum. 5.
Investigation by ultrasonography cystic pelviabdominal mass.
Treatment:
1. Active treatment depends on the site of obstruction.
2. Circulate incision for imperforated hymen.
3. Excision for transverse vaginal septum.
2. True amenorrhea Etiology:
1. General causes as: o Endocrinal causes as (hypo and hyperthyroidism,
uncontrolled D.M and adrenal gland disorder). o Non-endocrinal causes as
(Debilitating disease as T.B. malignancy & liver failure, obesity, underweight and
severe anaemia).
2. Specific causes as:
1. CNS and Hypothalamic amenorrhea:
Etiology: Organic lesions, traumatic, inflammatory as meningitis and encephalitis
or neoplasm. Psychological disturbance as pseudocyesis (false pregnancy),
anorexia nervosa depression, and prolonged vigorous exercise. o Prolactin drugs
as (Estrogens).
Menstrual Cramps (Dysmenorrhea): Most women have experienced
menstrual cramps before or during their periods at some point in their lives. For
some, it is part of the regular monthly routine, but if cramps are especially painful
and persistent, this is known as dysmenorrhea. This disorder is classified into
primary and secondary a. Primary dysmenorrhea or (spasmodic and membranous
dysmenorrhea).
1. Spasmodic dysmenorrhea is a common complaint in young girls
(teenagers) pain occurs in absence of any organic pelvic lesion.
Age: (starts 1 or 2 years after menarche).
Parity: pain improves with abortion or labour.
Type of pain: colicky intermittent pain starts on the first day of
menstruation and ceases with the onset of menstruation blood flow.
Region: It felt in the supra public area and in the front and inner sides
of thigh.
Etiology: More than one theory explains spasmodic dysmenorrhea:
• Abnormal anatomy: As Cervical obstruction & uterine hyperplasia
• Abnormal physiology: o Low pain threshold, uterine ischemia,
Hormonal imbalance, and Prostaglandin effect causes contraction of the
gut muscle, nausea, Vomiting and diarrhoea.
• General causes: As psychological disturbance and smoking.
2. Membranous dysmenorrhea: It is a rare type of spasmodic
dysmenorrhea in which severe pain is relieved only by passage of an
endometrial cast during 3rd or 4th day of menstruation.
Signs and symptoms:
1. Pain concentrated in the lower abdomen, in the umbilical region or
the suprapubic region of the abdomen. It is also commonly felt in the
right or left abdomen.
2. It may radiate to the thighs and lower back. nausea and vomiting,
diarrhea or constipation, headache, dizziness, disorientation,
hypersensitivity to sound, light, smell and touch, fainting, and fatigue.
Symptoms of dysmenorrhea often begin immediately following
ovulation and can last until the end of menstruation. This is because
dysmenorrhea is often associated with changes in hormonal levels in
the body that occur with ovulation. The use of certain types of birth
control pills can prevent the symptoms of dysmenorrhea, because the
birth control pills stop ovulation from occurring.
Treatments
1. Nutritional Several nutritional supplements have been indicated as
effective in treating dysmenorrhea, including magnesium, zinc, and
thiamine (vitamin B1), Intake of thiamine was demonstrated to
provide "curative" relief in 87% of females experiencing
dysmenorrhea. Sources of vitamin B1 include (cereals especially
bread, and brown rice other foods that contain this vitamin include
 dairy products, yeast extract, nuts, seeds, and red meat), omega-3
fatty acids the richest dietary source of omega-3 fatty acids is found
in flax oil and sardine, vitamin E oral intake of vitamin E relieves
the pain of primary dysmenorrhea and reduces blood loss. NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in
relieving the pain of primary dysmenorrhea, can have side effects of
nausea, dyspepsia, peptic ulcer, and diarrhoea. Hormonal
contraceptives.
Non-drug therapies: Several non-drug therapies for dysmenorrhea
have been studied, including behavioural, acupuncture, acupressure,
chiropractic care, and the use of a TENS unit.
2. Hormonal treatments One study suggested that vasopressin
antagonists might be useful in treating a variety of disorders,
including dysmenorrhea. (Lemmens, et al 2008)
b. Secondary dysmenorrhea: Secondary dysmenorrhea is dysmenorrhea
which is associated with an existing condition. The most common cause of
secondary dysmenorrhea is endometriosis. Other causes include
leiomyoma. adenomyosis, ovarian cysts, and pelvic congestions, the
presence of a copper IUD can also cause dysmenorrhea.
Clinical picture: Age (>30 years), Parity (more in porous), Type of pain
(dull ache fell in lower abdomen and low back starts 3- 5 days before the
period and end with the onset of flow. Associated symptoms: menorrhagia,
Polymenorrhea and leucorrhoea.
Treatment of secondary dysmenorrhea: 1- Treatment of the cause. 2- 2-
Analgesics. 3- Measures to relieve pelvic congestion as warm vaginal
douches. Nursing Management: Instruction in menstrual hygiene-so that
her period does not seem distasteful and restricting, encourage frequent
bathing. Encourage to get more good posture and exercise particularly
aerobics (cycling, jogging, walking, and waist bending before the onset of
the period)
Avoidance over fatigue and overexertion during the period: Apply heat
(e.g. warm baths, putting a hot water bottle, or heating pads on the
abdomen), Focuses on education and psychosocial needs of the patient.
Encourages drinking plenty of fluids, but avoiding alcohol. Divert
attention, Encourage rest and sleep III. Abnormal Uterine Bleeding
Dysfunctional uterine bleeding can be caused by hormonal imbalances
75% of women with excessive menstrual bleeding have a hormone-related
disorder that is responsible for their abnormal uterine bleeding condition.
Hormonal imbalances occur when the body produces too much or not
enough of certain hormones. These imbalances may also be associated with
weight loss or gain of more than 15 pounds, a heavy exercise regimen,
significant stress, illness, and use of some medications such as
antianxiolytics like valium, and certain antipsychotic medications The
patterns of abnormal uterine bleeding may be in the form of menorrhagia,
hypomenorrhea, oligomenorrhea, or Polymenorrhea. a. Menorrhagia
(hypermenorrhea): Menorrhagia means regular menstruation occurring at
normal intervals, but it is excessive in amount or prolonged in duration or
both. (National Women's Health Resource Center, 2006).
Causes: There are several possible causes of menorrhagia, including the
following: Hormonal (particularly estrogen and progesterone) imbalance
(especially seen in adolescents who are experiencing their menstrual period
for the first time and in women approaching menopause). Pelvic
inflammatory disease (PID). Uterine fibroids. Abnormal pregnancy (i.e.,
miscarriage, ectopic). Infection, tumors, or polyps in the pelvic cavity.
Certain birth control devices (i.e., intrauterine devices or IUDs). Bleeding
or platelet disorders. Liver, kidney, or thyroid disease. Symptoms of
menorrhagia In general, bleeding is considered excessive when a woman
changes a soaks sanitary pad every hour. In addition, bleeding is
considered prolonged when a woman experiences a menstrual period that
lasts longer than 7 days in duration. The following are the most common
symptoms of menorrhagia. However, each individual may experience
symptoms differently. Symptoms may include: Spotting or bleeding
between menstrual periods, Spotting or bleeding during pregnancy.
Diagnosis Diagnostic procedures for menorrhagia include the following:
Blood tests, Pap test, Ultrasound (also called sonography), Biopsy
(endometrial):- hysteroscopy: - a visual examination of the canal of the
cervix and the interior of the uterus using a viewing instrument
hysteroscope inserted through the vagina. Dilation and curettage.
Complications: Anaemia may include shortness of breath, tiredness,
weakness, tingling and numbness in fingers and toes, headaches,
depression, becoming cold more easily, and poor concentration.
Treatment for menorrhagia includes: Iron supplementation (if the condition
is coupled with anaemia, a blood disorder caused by a deficiency of red
blood cells or haemoglobin) Prostaglandin inhibitors such as nonsteroidal
anti-inflammatory medications such as aspirin or ibuprofen (to help reduce
 cramping and the amount of blood expelled). Oral contraceptives
(ovulation inhibitors). Progesterone (hormone treatment). Endometrial
ablation: is a treatment that destroys or removes most of the lining of the
uterus.
3. Fertility disorders: Fertility disorders, also known as infertility, refer to
the inability of a couple to conceive after a year of regular, unprotected
sexual intercourse. Infertility can affect both men and women and may
result from various factors. Here are some common causes and aspects
related to fertility disorders:
Ovulatory Disorders: Conditions such as polycystic ovary syndrome
(PCOS) and hypothalamic dysfunction can disrupt the regular release of
eggs from the ovaries.
Uterine or Tubal issues: Structural abnormalities in the uterus or fallopian
tubes, as well as blockages, can hinder the fertilization process.
Sperm Disorders: Problems with sperm production, quality, or delivery can
contribute to infertility. Conditions like low sperm count, poor sperm
motility, and abnormal sperm morphology are examples.
Varicocele: Enlarged veins in the testicles (varicocele) can affect sperm
polycystic ovary syndrome (PCOS): polycystic ovary syndrome (PCOS)
was hypothesized to result from functional ovarian hyperandrogenism
(FOH) due to dysregulation of androgen secretion in 1989 –1995.
Subsequent studies have supported and amplified this hypothesis. When
defined as otherwise unexplained hyperandrogenicoligoan ovulation, two-
thirds of PCOS cases have functionally typical FOH, characterized by 17-
hydroxyprogesterone hyperresponsiveness to gonadotropin stimulation.
Two-thirds of the remaining PCOS have FOH detectable by testosterone
elevation after suppression of adrenal androgen production. About 3% of
PCOS have a related isolated functional adrenal hyperandrogenism. The
remaining PCOS cases are mild and lack evidence of steroid secretory
abnormalities; most of these are obese, which we postulate to account for
their atypical PCOS. Approximately half of normal women with polycystic
ovarian morphology (PCOM) have subclinical FOH-related steroidogenic
defects. Theca cells from polycystic ovaries of classic PCOS patients in
long-term culture have an intrinsic steroidogenic dysregulation that can
account for the steroidogenic abnormalities typical of FOH. These cells
overexpress most steroidogenic enzymes, particularly cytochrome
P450c17. Overexpression of a protein identified by genome-wide
association screening, differentially expressed in normal and neoplastic
development 1A.V2, in normal theca cells has reproduced this PCOS
 phenotype in vitro. A metabolic syndrome of obesity-related and/or
intrinsic insulin resistance occurs in about half of PCOS patients, and the
compensatory hyperinsulinism has tissue-selective effects, which include
aggravation of hyperandrogenism. PCOS seems to arise as a complex trait
that results from the interaction of diverse genetic and environmental
factors. Heritable factors include PCOM, hyperandrogenaemia, insulin
resistance, and insulin secretory defects. Environmental factors include
prenatal androgen exposure and poor fetal growth, whereas acquired
obesity is a major postnatal factor. The variety of pathways involved and
lack of a common thread attests to the multifactorial nature and
heterogeneity of the syndrome. Further research into the fundamental basis
of the disorder will be necessary to optimally correct androgen levels,
ovulation, and metabolic homeostasis. (Endocrine Reviews 37: 467–520,
2016) I. Polycystic ovary syndrome (PCOS) is the most common endocrine
disorder in reproductive aged women, with a prevalence between 5% and
15%, depending on the diagnostic criteria applied. PCOS was first
described by Stein and Leventhal as a syndrome of oligo-amenorrhea and
polycystic ovaries that was variably accompanied by hirsutism, acne, and
obesity. Demonstration of polycystic ovaries became required for PCOS
diagnosis, which required gynaecologic expertise, yet polycystic ovaries
were found to be variably associated with the signs and symptoms that
characterize the disorder. Seminal contributions to our understanding of
PCOS pathogenesis began with the 1958 report that urinary LH was
elevated by bioassay in the 4 cases studied. The 1970 documentation by
RIA that serum LH and the ratio of LH to FSH were typically high led both
to the adoption of altered gonadotropin secretion as an alternative
diagnostic tool and to a focus of research on the putative neuroendocrine
genesis of the syndrome. Shortly thereafter, plasma free testosterone was
recognized as a marker for hyperandrogenism in hirsute amenorrhea
women; subsequent studies suggested the hyperandrogenaemia was of
ovarian origin. During the 1980s, administration of testosterone to female-
to-male transsexuals was found to cause polycystic ovaries, and
ultrasonographic criteria for the identification of polycystic ovarian
morphology (PCOM) were developed. Meanwhile, significant insulin
resistance was recognized to be related to hyperandrogenism and
acanthosis nigricans and to occur independently of obesity in the
syndrome.
INFERTILITY
 Infertility- the inability to achieve or sustain pregnancy is not a
disease in the usual sense of the word. It is not a symptom or condition that
prevents the physical wellbeing of the infertile individual or couple.
However, since the desire to have children can be exceptionally strong for
biological and social reasons (indeed, empires have fallen due to a ruler's
infertility), it is certainly an important condition in our society, and it is
usually managed in the context of clinical medicine. Diagnosing Infertility
There is no precise definition of infertility. Rather, infertility is the absence
of pregnancy alter an appropriate duration of attempting conception by
regular intercourse. This duration differs between and within cultures.
Population conception curves reveal that 80 percent of couples will have
achieved a conception by 12 months and 90 percent by 18 months. The
remaining 10 percent may be labelled as "infertile or "'sub fertile."
infertility can be caused by failure to ovulate a mature oocyte, by few or
defective sperm, by physical blockage of the male or female ducts, or by
incompatibilities between the sperm and the milieu of the egg or the
reproductive tract (McVeigh and Barlow 2000). While there are numerous
treatments for women that can lead to the maturation and ovulation of
oocytes, there are relatively few treatments for men who are not making
sufficient sperm. In women, exogenous gonadotropins or anti-estrogenic
drugs (clomiphene or tamoxifen) can be used to stimulate the ovaries. In
men, sperm may be concentrated and injected either into the oocyte or into
the reproductive tract near the oocyte. There are also several assisted
reproductive technologies (ART), which are medical techniques that
enhance the probability of fertilization by manipulating the oocyte outside
of the woman's body. The most widely practiced of these techniques is in
vitro fertilization.
In vitro fertilization (IVF) is an assisted reproductive technology in
which oocytes and sperm retrieved from the male and female partners are
placed together in a petri dish, where fertilization can take place. After the
fertilized eggs have begun dividing, they are transferred into the female
partner's uterus, where implantation and embryonic development can occur
as in a typical pregnancy. IVF was developed in the early 1970s to treat
infertility caused by blocked or damaged fallopian tubes. The first IVF
baby; Louise Brown, was born in England in 1978. Since then, the number
of lVF or ocedures performed each year has increased and their success
rate has improved. (IVF success rates compare favourably to natural
pregnancy rates in any given month when the woman is under age 40 and
there are no sperm problems; see Trounson and Gardner 2000.) In part
 because it is so widely publicized, many people mistakenly believe that
IVF is the only treatment option for infertile couples. Actually, fewer than
5 percent of all patients who seek treatment for infertility receive IVF. Most
infertile couples respond well to less complicated treatment options, such
as hormonal therapies and artificial insemination. However, IVF remains
the most commonly used of the ART procedures. The IVF procedure The
IVF procedure has four basic steps: Step 1: Ovarian stimulation and
monitoring. Having several mature oocytes available for TVF increases the
possibility that at least one will result in a pregnancy. Typically. women
are injected with gonadotropins or antiestrogens over a period of days or
weeks in order to "hyperstimulate" the ovaries to produce mature oocytes.
Step 2: Egg retrieval. Once the follicle has matured (but not yet ruptured),
the physician retrieves as many oocytes as possible. This is done surgically,
guiding an aspiration pipette to each mature follicle and sucking up the
oocyte. Once recovered, those oocytes that are mature and healthy are
transferred to a sterile container to await fertilization in the laboratory. Step
3: Fertilization. A semen sample is collected from the male partner
approximately 2 hours before the female partner's oocytes are retrieved.
These sperm are processed by a procedure called sperm washing. Sperm
washing capacitates the sperm and selects only the healthiest and most
active sperm in the sample. The selected sperm are placed in a petri dish
with the oocytes, and the gametes are incubated at body temperature. In
general, each oocyte is incubated for 12-18 hours with 50,000-100,000
motile sperm. If fertilization is successful, the eggs will begin to divide.
The success rate for achieving fertilization in this way is between 50 and
70 percent. Step 4: Embryo transfer. Embryo transfer is not complicated
and can be performed without anaesthesia or sur In cases in which
fertilization has been achieved in vitro, but after a number of cycles,
implantation into the uterus fails, the physician may suggest "assisted
hatching," in which a small hole is lysed in the zona pellucida prior to
inserting the embryo into the uterus. This procedure ensures that the
embryo will be able to hatch from the zona pellucida in time to adhere to
the uterus.
Success rates and complications of IVF
The rate of delivery of live babies per oocyte retrieval depends on the age
of the female partner. Some recent statistics suggest that approximately 31
couples out of every 100 who try one retrieval with IVF are likely to
achieve pregnancy and delivery. Compared with the one in four (25
percent) probability of achieving conception in a given cycle for normal
 healthy couples using unprotected intercourse, IVF offers improved
chances of conception to some infertile couples. The success rate drops to
25.5 percent, however, for women 35-37 years of age, and to 17.1 percent
for women 38-40. After 40 years of age, the success rate is less than 5
percent (CDC 2002a; Speroff and Fritz 2005). This decline may be due to
the declining viability of eggs as women ad Vance in age.
The lVF procedure has been very successful in achieving pregnancy, and
the more embryos are transferred, the greater the chance of pregnancy.
Thus, physicians typically transfer several embryos-thus increasing the risk
of multiple births. The rate of multiple births depends on the number of
embryos transferred, and also on the woman's age. According to one set of
statistics (Speroff and Fritz 2005), when three embryos were transferred,
the multiple birth rate was 46 percent for women aged 20-29; the rate was
39 percent for women aged 40-44 when seven or more embryos were
transferred. The risk of multiple births is a serious concern because
multiple-birth infants are predisposed to many health problems, including
malformations, infant death, premature delivery, and low birth weight (Lip
Shultz and Adamson 1999; Schieve et al. 1999; Bhattacharya and
Templeton 2000; Gleicher et al. 2000). Babies born prematurely and at low
birth weight are at risk for cerebral palsy and chronic respiratory problems.
In addition, mothers who carry multiple infants are also at risk for many
health conditions and complications (e.g., high blood pressure, diabetes),
and the costs for multiple pregnancies are also greatly increased. (See
Gilbert et al. 2005 for a discussible of this and other social considerations
surrounding assisted reproductive technologies.
Prenatal Diagnosis and Preimplantation Genetics
One of the consequences of in vitro fertilization and the ability to detect
genetic mutations early in development is a new area of medicine called
preimplantation genetics. Preimplantation genetics seeks to test for genetic
disease before the embryo enters the uterus. After that, many genetic
diseases can still be diagnosed before a baby is born. This prenatal
diagnosis can be done by chorionic villus sampling at 8-1 0 weeks of
gestation, or by amniocentesis around the fourth or fifth month of
pregnancy. Chorionic villus sampling and amniocentesis Chorionic villus
sampling involves taking a sample of the placenta, whereas amniocentesis
involves taking a sample of the ammonic fluid. In both cases, fetal cells
from the sample are grown and then analysed for the presence or absence
of certain chromosomes, genes, or enzymes. However useful these
procedures have been in detecting genetic disease, they have brought with
them a serious ethical concern: if a fetus is found to have a genetic disease,
the only means of prevention presently available is to abort the pregnancy.
The need to make such a choice can be overwhelming to prospective
parents.1t Indeed, the waiting time between knowledge of being pregnant
and the results from amniocentesis or chorionic villus sampling has created
a new phenomenon, the "tentative pregnancy." Many couples do not
announce their pregnancy during this stressful period for fear that it might
have to be terminated (Rothman et al. 1995). By using IVF, one can
consider implanting only those embryos that are most likely "When does a
human life begin? For a discussion of the differing views held by scientists,
as well as an overview of the theological positions, (Gilbert et al. 2005 and
Website 2.1). to be healthy than aborting that foetus that are most likely to
produce malformed or nonviable children. This can be achieved by
screening embryonic cells before the embryo is implanted in the womb.
While the embryos are still in the petri dish (at the 6- to 8-cell stage), a
small hole is made in the zona pellucida and two blastomeres are removed
from the embryo. Since the mammalian egg undergoes regulative
development, the removal of these blastomeres does not endanger the
embryo, and the isolated bias timers are tested immediately. The
polymerase chain reaction technique can be used to determine the presence
or absence of certain genes to be determined, and fluorescent in situ
hybridization (FISH) can be used to determine whether the normal
numbers and types of chromosomes are present (Kanavakis and
Traeger·Synodinos 2002; Miny et al. 2002). Results are often available
within 2 days. Presumptive wildtype embryos can be implanted into the
uterus, while any presumptive embryos with deleterious mutations are
discarded. Sex selection and sperm selection the same procedures that
allow preimplantation genetics also enable the physician to know the sex
of the embryo. Sometimes parents wish to have this information; Pre
implantation genetics is performed on one or two blastomeres (seen here
in the pipette) taken from an early blastocyst. The polymerase chain
reaction is then used to determine whether certain genes in these cells are
present. absent, or mutant. (Photograph courtesy of The Institute for
Reproductive Medicine and Science of St. Barnabas, Livingston, NJ.)
sometimes they do not. However, knowing the sex of an embryo prior to
its implantation raises the possibility that parents could decide to have only
embryos of the desired sex implanted. Sex selection using preimplantation
genetics is seen by many as a beneficial way of preventing X-linked
diseases, but in fact it is often used as a method of simply choosing your
 offspring's sex. Opponents of sex selection point to its possible use to
prevent the birth of girls in cultures where women are not as highly valued
as men (see Gilbert 2005). Different countries and even different hospitals
have different policies permitting preimplantation genetic diagnosis solely
for the purpose of sex determination. Another way to accomplish sex
selection is through sperm selection. The X chromosome is substantially
larger than the Y chromosome; therefore, human sperm cells containing an
X chromosome contain nearly 3 percent more total DNA than sperm cells
containing a Y chromosome. This DNA difference can be measured, and
the X-and Y bearing sperm cells separated based on their size/mass ratio,
using a flow cytometer. The separated sperm can then be used for artificial
insemination or in vitro fertilization. Recent studies have shown that this
technique is about 90 percent reliable for sorting X-bearing sperm, and
about 78 percent reliable for sorting Y-bearing sperm (Stern et al. 2002).
In vitro fertilization (IVF) is an assisted reproductive technology (ART) that
involves fertilizing an egg with sperm outside the body and then implanting
the fertilized embryo into the uterus. Over the years, advancements in IVF
technology have improved success rates and expanded the options available
to individuals and couples seeking fertility treatment. Here are some advanced
techniques and technologies associated with IVF:
1. Intracytoplasmic sperm injection: ICSI involves injecting a single sperm
directly into an egg to facilitate fertilization. This technique is particularly
useful in cases of male infertility where sperm may have difficulty
penetrating the egg on their own.
2. Preimplantation genetic testing:
PGT allows for the screening of embryos for genetic abnormalities before
implantation. There are two main types: PGT-A (formerly known as PGS),
which screens for chromosomal abnormalities, and PGT-M (formerly
known as PGD), which tests for specific genetic disorders.
3. Blastocyst culture
Embryos are typically cultured for a few days before transfer.
Advancements in culturing techniques have allowed for extended culture
to the blastocyst stage (around day 5 or 6), which may improve the
selection of viable embryos.
4. Time-lapse imaging:
Time-lapse imaging involves continuous monitoring of embryo development
using specialized cameras. This allows embryologists to assess key
developmental milestones without disturbing the embryo, potentially
improving the selection of embryos for transfer.
5. Egg freezing (oocyte cryopreservation)
Egg freezing allows women to preserve their eggs for future use. This can be
beneficial for individuals facing medical treatments that may affect fertility or
those who wish to delay childbearing.
6. Frozen embryo transfer
Instead of transferring embryos immediately after fertilization, embryos can
be cryopreserved and stored for later use. FET allows for better
synchronization with the woman's natural menstrual cycle.
7. Assisted hatching:
Assisted hatching involves creating a small opening in the outer layer of the
embryo (the zona pellucida) before transfer. This may aid in the embryo's
ability to implant in the uterus.
8. Egg donation and sperm donation:
Donor eggs or sperm can be used when one or both partners have fertility
challenges. This allows individuals or couples to achieve pregnancy using
gametes from a donor.
It's important to note that the appropriateness of these advanced techniques
depends on individual circumstances, and not all individuals or couples will
require or benefit from them. A fertility specialist can provide personalized
guidance based on a thorough assessment of the specific situation. Advances
in IVF technology continue to evolve, offering new possibilities and improved
outcomes for individuals and couples seeking fertility treatment.
In vitro fertilization (IVF) is generally a safe and effective fertility treatment,
but like any medical procedure, it comes with certain risks and considerations.
It's important for individuals or couples considering IVF to be aware of these
potential risks and discuss them thoroughly with their healthcare providers.
Here are some common risk associated with IVF:
1. Multiple pregnancy:
One of the main risks of IVF is the increased likelihood of multiple
pregnancies, such as twins or triplets. Multiple pregnancies carry higher risks
for both the mother and the babies, including preterm birth and low birth
weight.
 2. Ovarian Hyperstimulation Syndrome
OHSS is a condition where the ovaries become swollen and painful due to the
use of fertility medications to stimulate egg production. Severe cases can lead
to abdominal pain, nausea, and difficulty breathing. Monitoring and adjusting
medication doses can help reduce the risk.
3. Egg Retrieval risks:
During the egg retrieval procedure, there is a slight risk of bleeding, infection,
or damage to surrounding organs. These risks are generally low but should be
discussed with the healthcare team.
4. Embryo Transfer Risks:
While rare, there is a small risk of infection or injury during the embryo transfer
procedure. Most embryo transfers are, however, minimally invasive and have a
low risk of complications.
5. Ectopic Pregnancy:
The risk of ectopic pregnancy (where the embryo implants outside the uterus,
usually in the fallopian tube) may be slightly higher after IVF. Close
monitoring and early detection can help manage this risk.
6. Miscarriage:
The risk of miscarriage with IVF is similar to that of natural conception.
Various factors, including the age of the woman and the quality of the
embryos, can influence the risk of miscarriage.
7. Birth Defects:
Some studies suggest a slightly higher risk of certain birth defects with IVF,
although the overall risk remains relatively low. It's essential to discuss this
risk with the healthcare provider.
8. Emotional and psychological impact:
The emotional toll of IVF can be significant. The process may involve
multiple cycles, and not all attempts are successful. Couples may experience
stress, anxiety, or depression during the treatment.
9. Financial costs:
IVF can be expensive, and the financial burden can be a source of stress for
individuals or couples undergoing treatment. It's important to consider the
financial aspects and plan accordingly.
10. Ovarian Cancer Risk:
Some studies suggest a possible association between certain fertility
medications and a slightly increased risk of ovarian cancer. However, the
overall risk is considered low, and the relationship is complex and not fully
understood.
It's crucial for individuals or couples considering IVF to have open and
thorough discussions with their healthcare providers about the potential risks
and benefits. The decision to pursue IVF should be based on a comprehensive
assessment of the individual's medical history, fertility issues, and overall
health. Counselling and support services may also be beneficial to help
individuals cope with the emotional aspects of the IVF process.
The concept of "designer babies" and the use of in vitro fertilization (IVF)
technologies involve various ethical considerations and are subject to
regulatory laws and guidelines. Here are key aspects related to the ethics,
regulatory laws, and guidelines of IVF:
Ethics of IVF and Designer Babies:
1. Autonomy and Reproductive Choice:
IVF allows individuals or couples to make reproductive choices, including
the selection of embryos based on certain genetic traits. The ethical
principle of autonomy supports an individual's right to make decisions
about their reproductive health.
2. Respect for Embryos:
Ethical debates often centre around the status and treatment of embryos.
Some view embryos as deserving of moral consideration, while others
prioritize the autonomy and well-being of the potential parents.
3. Equity and Access:
There are concerns about the equitable access to IVF technologies. Issues
of affordability and accessibility may raise ethical questions about who
gets to benefit from these technologies.
4. Non-Discrimination:
Ethical guidelines emphasize the importance of avoiding discrimination
based on genetic traits. Selecting embryos based on certain traits could
raise concerns about reinforcing societal biases or stigmatizing certain
characteristics.
5. Balancing individual and societal interests:
 Decisions about designer babies involve a delicate balance between
individual rights and the potential societal impacts, such as exacerbating
social inequalities or creating unrealistic expectations.
6. Informed Consent:
Informed consent is a critical ethical principle in IVF. Individuals
undergoing IVF should be fully informed about the procedures, potential
risks, and the implications of selecting embryos with specific traits.
Regulatory Laws and Guidelines for IVF:
1. International standards: While there are no global regulations,
international organizations such as the World Health Organization
(WHO) provide guidelines and recommendations. Countries often look
to these standards when developing their own regulations.
2. National Legislation: Each country has its own laws and regulations
governing assisted reproductive technologies, including IVF. These
regulations may cover issues such as the use of donor gametes, the
number of embryos to transfer, and the screening of embryos.
3. Reproductive ethics Committees: Many countries require the
establishment of ethics committees to review and approve research and
clinical practices related to reproductive technologies. These
committees assess the ethical implications and compliance with
regulations.
4. In Vitro Fertilization Protocols: IVF clinics must adhere to specific
protocols and standards to ensure the safety and efficacy of procedures.
These protocols may cover aspects such as ovarian stimulation, egg
retrieval, fertilization, and embryo transfer.
5. Genetic testing and counselling: Some countries regulate the use of
genetic testing in IVF, requiring pre-implantation genetic testing (PGT)
to adhere to specific guidelines. Genetic counselling may also be
recommended to help individuals make informed decisions.
6. Surrogacy laws
Laws regarding surrogacy, which is often associated with IVF, vary
widely. Some countries have strict regulations, while others may have
more permissive or restrictive approaches.
7. Donor Sperm and egg regulations:
Guidelines govern the use of donor sperm and eggs, covering issues
such as anonymity, compensation, and the number of offspring from a
single donor.
8. Patient Confidentiality
IVF clinics must adhere to strict patient confidentiality regulations to
protect the privacy of individuals undergoing fertility treatments.

THANK YOU. . .
Bibliography
➢ Scott F. Gilbert, Developmental Biology. Sunderland,
Massachusetts USA; Sinauer Associated Publishers, 2006. Pg.
655-664
➢ Unknown Source; Menstrual disorders, Available: 006 MENSTRUAL DISORDERS.pdf
via Internet Accessed 2023 Dec 23