As you settle in, please

take this opportunity to

put into off mod e your
cell-phones and any
other devices that ring,
beep, or play tunes.
1
Impotency, Sterility, Infertility,
Artificial Insemination,
Sperm donation.

- MD. ABUL MANSUR

 Impotence
Impotence is the inability of a person to
perform sexual intercourse.

3
 Sterility
Sterility is the inability of the male to begate
children, and in the female the inability to
conceive children.
About 10-15% of all married couples are
involuntarily sterile.

4
 Frigidity
• Frigidity is the inability to initiate or
maintain the sexual arousal pattern in the
female.

5
 Legality of impotence and sterility
Question arises-
• Civil
– Nullity of marriage
– Divorce
– Adultery
– Disputed paternity
– Legitimacy
– Suit for adoption

6
• Criminal
– Adultery
– Rape
– Unnatural sex offences

7
 CAUSES
• Age
• Developmental defects
• Acquired abnormalities
• Local diseases
• General diseases
• Psychical causes

8
 Sterilization
• It is the procedure to make a male or
female person sterile, without any
interference with potency.

9
 Types
• Compulsory
• Voluntary
– Therapeutic
– Eugenic
– Contraceptive

10
 Infertility
Infertility is defined as an inability to conceive a
child despite attempts to become pregnant over
the course of 12 months.
It refers to a state in which a couple has a
diminished capacity to conceive.
It should not be confused with sterility, which is a
physical inability to become pregnant.

11
There are many different causes of infertility.
About one-third of all infertility cases can be
attributed to males, another one-third to
females and the remaining one-third to
both members of a couple or to
unexplained causes.
The latter make up roughly 20 percent of
infertility cases.

12
 cause
Infertility occurs because the human reproductive
process is so intricate that even a minor
disruption may be enough to derail conception.
Each month, hormones produced in the woman’s
pituitary gland signals the ovaries to prepare
an egg for ovulation. These hormones are
called follicle-stimulating hormone (FSH)
and luteinizing hormone (LH).
Women are most fertile during this period of
ovulation, which occurs around the 14th day of
the menstrual cycle.
13
After a woman ovulates, the egg is captured by
the fallopian tube and begins its passage to the
uterus.
For fertilization to occur naturally, the sperm and
egg must unite in the fallopian tube.
The greatest odds of fertilization occur in the
first 12 hours. Sperm can fertilize the egg for
up to 72 hours after ejaculation.
If fertilized, the egg moves and implants into the
uterus two to four days later.
14
For conception to occur, hundreds of
variables must develop in just the right
way.
When no fertility problems are present, the
average couple between the ages of 29 and
33 has about a 20 to 25 percent chance of
becoming pregnant during any given
menstrual cycle.
15
Infertility results when something disrupts this
process and prevents conception.
This can be due to problems with the hormones,
the egg or sperm
or with transport,
penetration of the egg by sperm and fertilization,
or It can be due to medical or mechanical issues.

16
 Potential causes of infertility
There are many potential causes of infertility.
Overall, about one-third of infertility cases can be
attributed to males,
another one-third to females and
the remaining one-third to both members of a
couple.
At least 20 percent of infertility cases go
unexplained, although these couples often later
succeed in becoming pregnant.
17
 In female
• Ovulation abnormalities are responsible for two-
thirds of infertility problems
• Breakdown in a woman’s hormonal
communication cycle due to
– Direct injury to the hypothalamus or pituitary gland
– Pituitary tumors
– Anorexia nervosa
• ovaries no longer contain eggs
• scar tissue prevents ovulation
• the absence of menstruation (amenorrhea).
18
• Fallopian tube damage or blockage
• Endometriosis
• Adhesions
• Hormonal imbalances
• Polycystic ovarian syndrome
• STDs can lead to pelvic inflammatory
disease (PID)
• Early menopause
• Uterine fibroids
• Thyroid problems
• Diseases associated with amenorrhea
19
 Difficulties with a man
• Oligospermia or azoospermia
• Poor sperm motility
• Varicose veins in the scrotum
• Undescended testicle
• Testosterone deficiency
• Sexually transmitted diseases (STDs)
• General health and lifestyle- emotional stress,
alcohol use, drug use, other medical conditions
• Erectile dysfunction, misplaced urinary opening
in the penis with sometimes retrograde
ejaculation). 20
Treatment options for infertility
In 85 to 90 percent of all cases, infertility is
treated with either medication or surgery.
Less than 5 percent involve in-vitro
fertilization or other kinds of assisted
reproductive technologies (ART) is used to
try to help a couple.

21
• correct hormonal imbalances
• stimulate the production of mature eggs
• In-vitro fertilization (IVF)
• Donor egg
• Donor sperm
• Gestational hosting

22
 Artificial insemination
Artificial insemination (AI) is when sperm
is placed into a female's uterus
(intrauterine), or cervix (intracervical)
using artificial means rather than by
natural copulation.
Modern techniques for artificial insemination
were first developed for the dairy cattle
industry.
23
Human artificial insemination
In humans artificial insemination is usually
used as assisted reproductive technology
to treat infertility.
The aim is to impregnate the woman by non-
sexual insertion of sperm into the vagina or
uterus.

24
 Preparations
A woman's menstrual cycle is closely
observed, by tracking basal body
temperature and changes in vaginal
mucous, or using ovulation kits,
ultrasounds or blood tests.

25
Regarding the sperm donor, just as with in
vitro fertilization, it is recommended not to
ejaculate for a few days before the
procedure.
This is to ensure a higher sperm count.

26
When using intra-uterine insemination (IUI), the
sperm must immediately be “washed” in a
laboratory.
The process of “washing” the sperm increases the
chances of fertilization and removes any
chemicals in the semen that may cause
discomfort for the woman.
A chemical is added to the sperm that will separate
the most active sperm in the sample.
27
 Procedure
When an ovum is released, semen from
a donor is inserted into the female's
vagina or uterus.
If the procedure is successful, she conceives
and carries to term a baby as normal,
making her both the genetic and
gestational mother.

28
 Variations
Artificial insemination has several variations
both regarding the donor of the sperm and
the techniques used.

29
 Donor variations
Either the woman's husband's sperm (artificial
insemination by husband, AIH) or
a sperm donor (artificial insemination by donor,
AID) can be used.

Earlier, a popular form of (artificial insemination

combined AIC) was used, in which the sperm of
the husband and a donor were mixed.
The popularity of AIC has reduced to almost nil.

30
 Techniques
The easiest way to inseminate is by
intracervical insemination (ICI), where
semen are injected into the cervix with a
needle-less syringe.
Semen can be injected directly into the
uterus to improve the chance of
conception, in a process called
intrauterine insemination (IUI).
31
 In vitro fertilization (IVF)
In vitro fertilization (IVF) is a technique
in which egg cells are fertilised by sperm
outside the woman's womb, in vitro.
The term in vitro, from the Latin root
meaning in glass, is used, because early
biological experiments involving
cultivation of tissues outside the living
organism from which they came, were
carried out in glass containers such as
beakers, test tubes, or petri dishes.
32
A colloquial term for babies conceived as
the result of IVF, test tube babies,
refers to the tube-shaped containers of
glass or plastic resin, called test tubes,
that are commonly used in chemistry labs
and biology labs.
IVF is a major treatment in infertility when
other methods of assisted reproductive
technology have failed.
33
The first "test-tube
baby", Louise Brown,
was born in Oldham,
England, as a result on
July 25, 1978.

34
The process involves hormonally controlling
the ovulatory process, removing ova (eggs)
from the woman's ovaries and letting
sperm fertilise them in a fluid medium.
The fertilised egg (zygote) is then transferred
to the patient's uterus with the intent to
establish a successful pregnancy.

35
Oocyte with sorrounding granular cells
36
Oocyte
37
 Methods
Ovarian stimulation
by a regimen of fertility medications to
stimulate the development of multiple
follicles of the ovaries under close
monitoring.

38
Oocyte retrieval
The eggs are retrieved from the patient using a
transvaginal technique involving an ultrasound-
guided needle piercing the vaginal wall to reach
the ovaries.
Through this needle follicles aspirated, and the
follicular fluid is handed to the IVF laboratory to
identify ova and is usually done under conscious
sedation or general anesthesia.
39
Fertilization
In the laboratory, the identified eggs are stripped
of surrounding cells and prepared for
fertilisation.
In the meantime, semen is prepared for fertilisation
by removing inactive cells and seminal fluid.
The sperm and the egg are incubated together (at a
ratio of about 75,000:1) in the culture media for
about 18 hours. By that time fertilisation should
have taken place and the fertilised egg would
show two pronuclei.
40
In situations where the sperm count is low, a single
sperm is injected directly into the egg using
intracytoplasmic sperm injection (ICSI).

41
The fertilised egg is
passed to a special
growth medium
and left for about
48 hours until the
egg has reached
the 6-8 cell stage.

42
Selection
Embryos that have reached the 6-8 cell stage
are transferred into an extended culture
system at the blastocyst stage. Blastocyst
stage transfers have been shown to result
in higher pregnancy rates.
In Europe, day-2 transfers are common.

43
Embryo transfer
In countries such as the UK, Australia and New
Zealand, a maximum of two embryos are
transferred. A woman over 35 may have up to
three embryos transferred.
The embryos judged to be the "best" are
transferred to the patient's uterus through a
thin, plastic catheter, which goes through her
vagina and cervix.
Several embryos passed to improve chances of
implantation and pregnancy.

44
Success rate
While the overall live birth rate via IVF in
the U.S. is about 27% .
Where the woman's own eggs are used as
opposed to those of a donor, for women
under 35, the pregnancy rate is commonly
approximately 43%.
the rate falls drastically - to only 4% for
women over 42.

45
Complications
The major complication of IVF is the risk of
multiple births.
This is directly related to the practice of transferring
multiple embryos at embryo transfer.
Multiple births are related to increased risk of
pregnancy loss, obstetrical complications,
prematurity, and neonatal morbidity.

46
Controversy
Artificial insemination has become a
significant issue in recent years,
particularly in debates revolving around
surrogate parenting.
Legal issues have arisen in cases where the
gestational (and possibly genetic) mother
decides to keep the child.

47
Surrogate motherhood
A surrogate mother is a women who by
contract agrees to bear a child for some
one else.
Artificial insemination with the semen of the
barren women’s husband is carried out in a
hired women (womb leasing).

48
Ethics of sperm donation
• The rights of the sperm donor.
• The rights of the clients (who are
purchasing the sperm).
• The criteria by which sperm are collected
(i.e. choosing a donor who has certain
traits).
• The amount of sperm that a single man can
donate.
49
Think about it

THINK
51