Impotency, Sterility & Artificial Insemination

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 twothirds 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 20 ejaculation).

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 nonsexual 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 ultrasoundguided 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