Infertility — Revision Notes

⚡ 30-Second Revision

Infertility: — Inability to conceive after 12 months (or 6 months for women >35).
ARTs (Assisted Reproductive Technologies): — Techniques to aid conception.
IVF (In Vitro Fertilization): — Fertilization in vitro (outside body), embryo transferred to uterus.
ZIFT (Zygote Intrafallopian Transfer): — Fertilization in vitro, zygote transferred to fallopian tube.
GIFT (Gamete Intrafallopian Transfer): — Gametes (eggs + sperm) transferred to fallopian tube for in vivo fertilization.
ICSI (Intracytoplasmic Sperm Injection): — Single sperm injected into egg (part of IVF), for severe male infertility.
AI (Artificial Insemination): — Sperm directly introduced into female reproductive tract (e.g., IUI).
Male Factors: — Oligospermia, azoospermia, poor motility, blockages, varicocele.
Female Factors: — Anovulation (PCOS), blocked fallopian tubes (PID, endometriosis), uterine issues (fibroids).
Key Distinction: — In vivo (inside body) vs. In vitro (outside body) fertilization.

2-Minute Revision

Infertility is defined as the failure to conceive after a year of unprotected intercourse, with causes stemming from male, female, or combined factors. Male infertility often involves issues with sperm count, motility, or morphology, while female infertility commonly arises from ovulatory disorders (like PCOS), blocked fallopian tubes (due to PID or endometriosis), or uterine abnormalities.

Assisted Reproductive Technologies (ARTs) offer solutions. IVF involves external fertilization and uterine embryo transfer. ZIFT also features external fertilization, but transfers the resulting zygote into the fallopian tube.

GIFT is unique as it places unfertilized eggs and sperm directly into the fallopian tube for natural, in vivo fertilization. ICSI is a specialized IVF technique where a single sperm is injected into an egg, crucial for severe male infertility.

Artificial Insemination (AI) involves directly introducing sperm into the female reproductive tract. Remembering the site of fertilization and transfer for each ART is key for NEET.

5-Minute Revision

Infertility is a medical condition affecting a significant number of couples, characterized by the inability to achieve pregnancy after 12 months of regular, unprotected intercourse (or 6 months for older women).

Its causes are diverse, encompassing male factors such as oligospermia (low sperm count), asthenozoospermia (poor sperm motility), or blockages in the reproductive tract. Female factors are equally varied, including ovulatory disorders like Polycystic Ovary Syndrome (PCOS), tubal factors such as blocked fallopian tubes (often due to Pelvic Inflammatory Disease or endometriosis), and uterine abnormalities like fibroids.

When conventional treatments fail, Assisted Reproductive Technologies (ARTs) provide effective alternatives.

Key ARTs to remember for NEET:

1
In Vitro Fertilization (IVF): — This is the most common ART. Eggs are retrieved from the woman, and sperm from the man. Fertilization occurs *outside the body* (in vitro) in a laboratory dish. The resulting embryos are then cultured for a few days before being transferred into the woman's *uterus*. IVF is highly effective for blocked fallopian tubes or severe male factor infertility (often combined with ICSI).
2
Zygote Intrafallopian Transfer (ZIFT): — Similar to IVF, fertilization occurs *in vitro*. However, the fertilized egg, now a zygote, is then surgically transferred into the woman's *fallopian tube*. This allows the zygote to naturally travel to the uterus for implantation. It requires at least one healthy fallopian tube.
3
Gamete Intrafallopian Transfer (GIFT): — In this procedure, both unfertilized eggs (gametes) and sperm (gametes) are collected and then immediately transferred into the woman's *fallopian tube*. Fertilization is expected to occur *inside the body* (in vivo). This method also requires at least one healthy fallopian tube and is sometimes preferred for ethical reasons.
4
Intracytoplasmic Sperm Injection (ICSI): — Often performed as part of an IVF cycle, ICSI is specifically for severe male factor infertility. A single sperm is *directly injected* into the cytoplasm of an egg in vitro. The resulting embryo is then transferred to the uterus, similar to standard IVF.
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Artificial Insemination (AI): — This involves collecting and processing sperm (from partner or donor) and then *directly introducing* it into the female reproductive tract, most commonly into the uterus (Intrauterine Insemination - IUI). Fertilization occurs *in vivo*. It's used for mild male factor infertility, cervical mucus issues, or unexplained infertility.

For NEET, focus on the precise location of fertilization (in vitro vs. in vivo) and the specific stage of development (gamete, zygote, or embryo) that is transferred, along with the transfer site (fallopian tube vs. uterus) for each ART. Also, be aware of the primary indications for each procedure.

Prelims Revision Notes

Infertility & ARTs: NEET Quick Recall

1. Definition of Infertility:

Inability to conceive after 12 months of regular, unprotected intercourse.
For women >35 years: 6 months.
Primary Infertility: — Never conceived.
Secondary Infertility: — Conceived previously, now unable.

2. Causes of Infertility:

Male Factors (30-40%):

* Sperm Issues: Oligospermia (low count), Azoospermia (no sperm), Asthenozoospermia (poor motility), Teratozoospermia (abnormal morphology). * Transport Issues: Blockages (epididymis, vas deferens) due to infection/surgery. * Others: Varicocele, hormonal imbalance, erectile dysfunction.

Female Factors (40-50%):

* Ovulatory Disorders: Anovulation/Oligo-ovulation (e.g., PCOS, hypothalamic dysfunction, premature ovarian insufficiency). * Tubal Factors: Blocked/damaged fallopian tubes (e.g., PID, endometriosis, adhesions from surgery). * Uterine Factors: Fibroids, polyps, congenital anomalies, Asherman's Syndrome. * Cervical Factors: Abnormal mucus. * Age: Decreased egg quality/quantity.

Unexplained Infertility (10-20%): — No identifiable cause after standard tests.

3. Assisted Reproductive Technologies (ARTs):

IVF (In Vitro Fertilization):

* Fertilization: In vitro (outside body, lab dish). * Transferred: Embryo (2-8 cell stage or blastocyst). * Transfer Location: Uterus. * Indications: Blocked tubes, severe male factor, unexplained.

ZIFT (Zygote Intrafallopian Transfer):

* Fertilization: In vitro. * Transferred: Zygote (fertilized egg). * Transfer Location: Fallopian tube. * Requires: At least one healthy fallopian tube.

GIFT (Gamete Intrafallopian Transfer):

* Fertilization: In vivo (inside body, fallopian tube). * Transferred: Gametes (unfertilized eggs + sperm). * Transfer Location: Fallopian tube. * Requires: At least one healthy fallopian tube.

ICSI (Intracytoplasmic Sperm Injection):

* Technique used *within* IVF. * Procedure: Single sperm *directly injected* into egg cytoplasm. * Indications: Severe male factor infertility (very low count, poor motility, abnormal morphology, or fertilization failure in previous IVF).

AI (Artificial Insemination):

* Procedure: Processed sperm directly introduced into female reproductive tract. * Types: IUI (Intrauterine Insemination - most common), ICI, ITI. * Fertilization: In vivo. * Indications: Mild male factor, cervical factor, unexplained, single women/same-sex couples.

Vyyuha Quick Recall

In Vitro Fertilization: Inside Vessel, For Embryo Uterus. (In vitro, Embryo to Uterus)

Zygote Intrafallopian Transfer: Zygote Inside Fallopian Tube. (Zygote to Fallopian Tube)

Gamete Intrafallopian Transfer: Gametes Inside Fallopian Tube. (Gametes to Fallopian Tube)

IntraCytoplasmic Sperm Injection: Inject Cell Sperm In. (Sperm injected into egg cytoplasm)