Infertility and assisted reproduction

The essentials

Many couples are unable to produce children despite unprotected sexual cohabitation; this is infertility. Causes may be physical, congenital, related to disease, drugs, immunological or psychological, and the problem may lie with either partner. Specialised health care units can diagnose and correct some disorders. Where correction is not possible, assisted reproductive technologies (ART) help.

In in vitro fertilisation (IVF), ova from the wife or a donor and sperm from the husband or a donor are fused in the laboratory under conditions similar to those in the body. The embryo formed can be transferred to the female. This is popularly called the "test tube baby" programme. Transfer methods:

• ZIFT (zygote intra-fallopian transfer): the zygote or early embryo with up to 8 blastomeres is transferred into the fallopian tube.
• IUT (intra-uterine transfer): an embryo with more than 8 blastomeres is transferred into the uterus.
• GIFT (gamete intra-fallopian transfer): an ovum from a donor is placed in the fallopian tube of a woman who cannot produce ova but can provide a suitable environment for fertilisation and development.
• ICSI (intra-cytoplasmic sperm injection): a sperm is injected directly into the ovum in the laboratory.
• AI / IUI (artificial insemination / intra-uterine insemination): semen from the husband or a healthy donor is introduced into the vagina or uterus; useful when the male cannot inseminate or has a very low sperm count.

Key points

• Embryos formed by in vivo fertilisation in a female can also be transferred to another female (embryo transfer).
• ART requires specialised professionals and expensive equipment.
• Adoption is another option for childless couples.

Common mistakes

• In GIFT the gamete (ovum) is transferred; in ZIFT the zygote is transferred.