Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.

1. REPRODUCTIVE HEALTH
AJAY KUMAR GAUTAM
CLASS - XII

2. WHAT DO YOU MEAN BY
REPRODUCTIVE HEALTH
• Reproductive health refers to healthy
reproductive organs with normal functions.
However, it has broader perspective as it involves
well-being in other aspects too.
• According to WHO, reproductive health means
well being in physical, emotional, behavioural
and social aspects of reproduction.
• Therefore, reproductively, a healthy society
comprises of people having physically and
functionally normal reproductive organs and
normal emotional and behavioural interactions
among them in all sex- related aspects.

3. REPRODUCTIVE HEALTH- PROBLEMS AND
STRATIGIES
• Over Population
• Awareness about Reproduction
• Sex Education
• Knowledge of growth of Reproductive Organs and STDs
• Birth Control devices and care of mother and child
• Prevention of sex abuse and sex related crimes
• Information about Reproduction related problems
• Research in reproductive health area : CDRI ( Central Drug Research Institute,
Lucknow) – Saheli (Oral Contraceptive)
• Medical Facilities

4. • Family Planning programme was
initiated in 1951 in India.
• These program were popularly named
Reproductive and Child Health Care (
RCH) programmes.
REPRODUCTIVE HEALTH- PROBLEMS
AND STRATIGIES

5. AMNIOCENTESIS
• Amniocentesis is a foetal sex and disorder
determination test based on the chromosal pattern
of the embryo’s cell in the amniotic fluid
surrounding the developing embryo.
Procedure: Amniotic fluid contains cells from the skin
of the foetus and other sources. These cells can be
used to determine the sex of the infant, to identify
some abnormalities in the number of chromosomes
and to detect certain biochemicals and enzymatic
abnormalities. If it is established that the child is likely
to suffer from a serious incurable congenital defect,
the mother should get the foetus aborted.
• Misuse of Amniocentesis: It is misused to know the
sex of unborn baby followed by medical
termination of foetus, in case it’s female. (Foeticide)

6. MEASURES TO CONTROL
OVER POPULATION
• Education: People in reproductive age group,
should be educated about the advantage of small
family. Posters showing a happy couple with two
children with a slogan “Hum Do Humare Do”
should be displayed. Many couples even adopted
“One Child Norm”.
• Marriageable Age : Age of Female – 18 Yrs
Age of Male – 21 Yrs
• Incentives
• Family Planning : Birth control measures, which can
prevent Birth rate

7. HUMAN POPULATION GROWTH
• Human population growth is measured as the annual
average growth rate which is calculated as follows :
Average annual growth rate (in percent) =
Where, P1 is population size in the previous census;
P2 is population size in the present census; and
N is no. of years between two census.

8. 1. High birth rate but fluctuating
death rate,
2. Declining death rate and
continuing high birth rate,
3. Declining birth rate and death
rate,
4. Low death rate but fluctuating
birth rate
Population growth rate is indicated
by I) The annual average growth
rate
II) The doubling time
HUMAN POPULATION GROWTH

10. POPULATION STABILIZATION AND
BIRTH CONTROL
• INDIAN POPULATION:
• Population of India during Independence (1947) – 350
millions
• By May 2000 – 1 Billion i.e, 1000 million
• By May 2011 – 1.21 Billion
• Growth rate depends on birth(fertility) rate,
death(mortality) rate, migration and age sex ratio.

11. • Fertility ( Natality) : Fertility is the ability of the reproductively active individuals
to produce babies. Birth rate is the number of babies produced per thousand
individuals.
• Total Fertility rate ( TFR) – is the average number of children that can be born
to a woman during her lifetime. The total fertility rate varies from region to
region.
• Replacement level (RL) – Is the number of children a couple must produce to
replace themselves so as to maintain the population at Zero Growth level.
• RL is 2.1 in developed countries and 2.7 in developing countries due to a higher
death rate at immature age.
• Mortality: Mortality is the death rate per thousand individuals. Death rate has
fallen in most countries. It is due to improved personal hygiene, sanitation and
modern medicines.
• Demographers generally use crude birth rate and crude death rate. Crude birth
rate is the number of live births per thousand persons in the middle of a given
year (i.e., on July 07). Crude death rate is the number of deaths per thousand
persons in the middle of a given year (i.e., on July 07). The difference between
number of births and that of deaths is called the rate of natural increase. If birth
HUMAN POPULATION GROWTH

12. POPULATION EXPLOSION
• The increase in size and growth of human population
is called population explosion.
• The reason for high population explosion are,
• 1. Decline in death rate.
• 2. Longer life span.
• 3. Decline in maternal mortality rate.
• 4. Decline in infant mortality rate.

13. AGE AND SEX STRUCTURE
Age-sex pyramids between 1975 and
2000 – Developed Countries
Age-sex pyramids between 1975 and
2000 – Developing Countries

14. TYPES OF CONTRACEPTIVES

15. METHODS OF BIRTH CONTROL
• Contraceptives: These are the devices which prevent
conception or pregnancy without interferring in the reproductive
health of the individuals in any way.
• Characteristics of an ideal contraceptive are :
1. User friendly i.e, comfortable and easy to use.
2. Absence of side effects
3. Reversible i.e, when the user wants to conceive, it should be
easy to interrupted.
4. Completely effective against pregnancy.
5. Cheap in cost
6. Easily available
7. Should not disturb normal sexual desire

16. • These are several methods of
contraception – natural or traditional,
barrier, IUDs, Oral contraceptives,
injectables, implants and surgical methods.
• Couple Protection is the process of
brining eligible couples under family
planning measures. In India, it is over 55%
at present and is voluntary in nature.
• In 2004, there were 60.79 lakh IUD
insertion, 48.74 lakh sterilisations or
surgical interventions, 249.9 lakh condom
users and 87.54 lakh oral pill users.
METHODS OF BIRTH
CONTROL

17. TYPES OF CONTRACEPTIVES
Injectable
Contraceptives &
Implants
Natural
Method
Barrier
Method
Chemical
Method
Intra Uterine
Devices (IUD)
Birth Control Method
Emergency
Contraception
Surgical
Method
Periodic
Abstinence
Withdrawal
Method
Lactational
Amenorrhoea
Tubectomy
Vasectomy
Male & Female
Condoms, Cervical
Cap
Diaphragm
Vault Cap

18. NATURAL METHOD
Safe Period / Periodic Abstinence :
• Natural methods work on the principle ofavoiding chances of ovum and sperms meeting
Periodic abstinence is one such method in which the couples avoid or abstain írom coitus from
day 10 to 17 of the menstrual cycle when ovulation could be expected. As chances of fertilisation
are very high during this period, it is called the fertile period. Therefore, by abstaining from coítus
during this period, conception could be prevented.
Withdrawal Method / Coitus Interruptus :
Withdrawal or coitus interruptus is another method in which the male partner withdraws his penis
from the vagina just before ejaculation so as to avoid insemination.
Lactational Amenorrhoea :
• Lactational amenorrhoea (absence of menstruatíon) method is based on the fact that ovulation
do not Occur during the period of intense lactation following parturition. Therefore, as long as
the mother breast-feeds the child fully, chances of conception are almost nil. However, this
method has been reported to be effective only upto a maximum period of six months following
parturition.
As no medicines or devices are used in these methods, side effects are almost nil. Chances of
failure, though, of this method are also high.

19. BARRIER METHOD
• Male Condoms,
• Female Condoms
• Cervical Cap
• Diaphragm
• Vault Cap
• In barrier methods, ovum and sperms are
prevented from physically meeting with the help
of barriers. Such methods are available for both
males and females.
• Condoms are barriers made of thin rubber/ latex
sheath that are used to cover the penis in the
male or vagina and cervix in the female, just
before coitus so that the ejaculated semen would
not enter into the female reproductive tract.
• This can prevent conception. ‘Nirodh’ is a
popular brand of condom for the male.
• Use of condoms has increased in recent years due
to its additional benefit of protecting the user
from contracting STls and AIDS.
• Both the male and the female condoms are
disposable, can be self-inserted and thereby gives
privacy to the user.

21. CHEMICAL METHOD
• They are the contraceptives which contain
spermicidal chemicals.
• The chemical contraceptives are available in the
form of creams (Eg, - Delfen), jellies (
perception, volar paste), foam tablets (
Aerosol foam, chlorimin T or Contain).
• They commonly contain lactic acid, boric acid,
citric acid, zinc sulphate and potassium
permanganate.
• The contraceptives are introduced in vagina prior
to sex.
• Sponge is a foam suppository or tablet
containing nonoxynol-9 as spermacide.
• It kills the sperm by disturbing the membrane.
It is moistened before use to activate the
spermicide.

22. INTRA UTERINE DEVICES (IUD)
• These devices are inserted by doctors or expert
nurses in the uterus through vagina.
TYPES:
1. Non-medicated- LIPPES loop
2. Copper releasing IUDs – (Cu7, Cu T, MULTILOAD375)
3. Hormone releasing IUDs – (LNG- 20, PROGESTASERT)
Principle of IUD:
• IUDs INCREASE PHAGOCYTOSIS OF SPERMS WITHIN THE
UTERUS AND THE Cu IONS RELEASED SUPPRESS SPERM
MOTILITY AND THE FERTILIZING CAPACITY OF SPERMS.
• The hormone releasing IUDs make the uterus
unsuitable for implantation and the cervix hostile to the
sperms.
• IUDs are ideal contraceptives for the females who want
to delay pregnancy or space children.

23. • They are in the form of tablets, hence called pills.
• Hormonal pills act in following ways :
1. Inhibition of ovulation
2. Inhibition of motility and secretory activity of
oviducts (Fallopian Tube).
3. Changing in cervical mucus impairing it’s ability to
allow the passage and transport of sperm.
4. Alteration in uterine endometrium to make it
unsuitable for Implantation.
ORAL CONTRACEPTIVES (ORAL PILLS)

24. TYPES OF ORAL CONTRACEPTIVES
• Mini-pills :
• They contain progestin only (with no
oestrogen).
• Saheli contains non-steroidal preparation
called centchroman which is taken once in a
week after an initial intake of twice a week dose
for 3 months.
• It has high contraceptive value and a very little
side effects .
• “Saheli” contraceptive pill has been developed
at CENTRAL DRUG RESEARCH INSTITUTE, LUCKNOW

25. Contraceptives Pills:
• They are most commonly used oral contraceptives pills.
• They contain synthetic progesterone and estrogen to
check ovulation.
• Pill Mala D and Mala N are commonly used combined
Contraceptives pill
• They are taken daily without break.
• Oral contraceptives pills increases the risk of intravascular
clotting.
• Therefore, they are not recommended for women with a
history of disorder of blood clotting, Cerebral blood
vessel damage, hypertension, liver malfunction, heart
disease or cancer of the breast or reproductive system.
TYPES OF ORAL CONTRACEPTIVES

26. MALE PILLS
• Glossypol - Made from cotton seeds.
• This pill prevent spermatogenesis.
• Now it has been banned because it cause
permanent azoospermia (Preventing
spermatogenesis).
• Only Progesterone hormone can be used in
male oral pills.
• In July 2000 China made Progesterone pills for
male (First time in World).

27. INJECTABLE CONTRACEPTIVES AND
IMPLANTS
• Progestogens alone or in combination with estrogen can
also be used by females as injections or implants under the
skin. Their mode of action is similar to that of pills and
their effective periods are much longer. Administration of
progestogens or progestogen-estrogern combinations or
IUDs within 72 hours of coitus have been found to be very
efective as emergency contraceptives as they could be
used to avoid possible pregnancy due to rape or casual
unprotected intercourse.

28. MORNING AFTER PILLS
(EMERGENCY CONTRACEPTIVE)
• Implantation can also checked by so called
morning after pills also known as emergency
contraceptive.
• These pills can prevent pregnany if taken
within 72 hours of Coitus (Copulation).
• Eg: I-pill, pill-72 and unwanted 72
• Most effective in first 24 hours.
• Side effects : Irregular Menstruation,
vomitting, breakthrough bleeding through
uterus etc.
• Very efective, as they could be used to avoid
possible pregnancy due to rape or casual
unprotected intercourse.

29. SURGICAL METHOD OF
CONTRACEPTION
• Surgical methods, also called sterilization , are generally advised
for the male/female partner as a terminal method to prevent
any more pregnancy.
• Surgical intervention blocks gamete transport and thereby
prevent conception. SURGICAL
METHOD
TUBECTOMY VASECTOMY
• Sterilisation procedure in the male is
called “Vasectomy”.
• In vasectomy, a small part of the vas
deferens is removed or tied up through a
small incision on the scrotum.
• Sterilisation procedure in the female is
called “Tubectomy”.
• In tubectomy, A small part of the
fallopian tube is removed or tied up
through a small incision in the abdomen
or through vagina.

30. SURGICAL METHOD OF
CONTRACEPTION

31. SURGICAL METHOD OF
CONTRACEPTION

32. SURGICAL METHOD OF
CONTRACEPTION
VASECTOMY TUBECTOMY

33. INDUCED ABORTION
• Abortion refers to the premature expulsion of the conception
products from the uterus, usually before 20th week of
pregnancy.
• An abortion may be spontaneous (naturally occurring),
sometimes called miscarriage or induced (intentionally
performed).
• When birth control methods are not used or fail to prevent an
unwanted pregnancy, induced abortion may be performed.
• Induced abortions may involve vaccum aspiration (suction),
infusion of a saline solution, or surgical evacuation (scraping).
• Certain drugs, most notably the French drug RU-486, can
induce, so called nonsurgical abortion, RU-486(mifepristone)
is an antiprogestin ; it blocks the action of Progesterone.

34. MEDICAL TERMINATION OF PREGNANCY
(MTP)
• It is voluntary or intentional abortion, induced and performed to end pregnancy before the
completion of full term.
• Nearly 20% of the total pregnancies get aborted , The number of MTPs is 40-50 million/year.
• Therefore MTPs have a significant role in containment of population though they are not performed
for this purpose.
• They are mainly meant for removing unsustainable pregnancies.
• Many countries do not have a law about MTPs because the latter involve emotional, ethical,
religious and social issues.
• In India, there is a proper act, Medical Termination of Pregnancy Act, 1971.
• It is mainly meant for preventing unnatural maternal deaths due to unsafe abortions, (8.9% of the
total maternal deaths), Act was amended in 2002.
• Under this act, termination of pregnancy can be done upto 20 weeks.
• If the pregnancy is likely to produce a congenitally malformed child, is a result of rape or
Contraceptive failure or is likely to harm the mother.

35. • MTP is safe if it’s performed upto 12 weeks (first trimester)
of pregnancy.
• Misoprostol (prostaglandins) along with mifepristone
(antiprogestin) is an effective combination.
• Vacuum aspiration and surgical procedures are adopted
thereafter.
• Second trimester abortions are risky.
• It has resulted in large scale female foeticide and
complications due to unsafe abortions in the hands of
untrained person.
• To prevent such mis-happenings, the government has
enacted a law , Pre – natal diagnostic techniques
(Regulation and Prevention of Misuse) Act, 1994 with
amendments in 2003.
MEDICAL TERMINATION OF PREGNANCY
(MTP)

36. SEXUALLY TRANSMITTED DISEASES
• The general term sexually transmitted disease (STD) is applied to any of the large
group of diseases that can be spread by sexual contact.
• The group traditionally specified as veneral diseases (VD).
• These disease may be contracted by other ways also.
• STDs are also called RTI ( Reproductive Tract Infections).
• Except for Hepatitis-B, genital herpes and HIV infections, other STDs are completely
curable if detected early and treated properly.
• Early symptoms include itching, fluid discharge, slight pain, swellings etc in the
genital region.
• Later complications include Pelvic Inflammatory Disease (PID), abortions, still births,
ectopic pregnancies, Infertility or even cancer of the reproductive tract.
• Though all the person are vulnerable to these infections, but these incidences are
high among persons in the age group of 15-24 years.

37. SEXUALLY TRANSMITTED
DISEASES (STD)
CHLAMYDIA – Chlamydia trachomatis
GONORRHOEA – Neisseria gonorrhoea
SYPHILIS – Treponema pallidum
GENITAL HERPES – Type II herpes
simplex virus (HSV-2)
CHANCROID – Haemophilus ducrei
GENITAL WARTS – Human Papilloma
Virus (HPV)
AIDS – Human Immunodeficiency
Virus (HIV)
TRICHOMONIASIS – Trichomoniasis
vaginalis

38. • Causitive agent : Chlamydia trachomatis
• Chlamydia is a sexually transmitted disease caused by the unusual bacterium which cannot reproduce outside the body
cells; it “cloaks” itseif inside the cells to divide.
• In males, urethritis is the principal result. Symptoms of urethritis,
• Thick discharge
• Burning on urination
• Painful Urination
• Without treatment, the Epididymis may also become inflamed, leading to sterility.
• In females, the most common site of infection is the cervix, resulting in cervicitis and production of a thick mucus and
pus discharge.
• Pelvic soreness
• Lower back pain
• Abdominal Pain
• Uterine tubes may be inflmammed, which increases the risk of ectopic pregnancy and sterility due to formation of scar
tissue in the tubes.
• Chalmydia may be passed from mother to infant during childbirth, infecting the eyes.
• Treatment consist of administration of Tetracycline or Doxycycline
Males
Females
CHLAMYDIA

39. CHLAMYDIA

40. GONORRHOEA
• Gonorrhoea or “clap” is an infectious sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae.
• Discharge from infected mucous membranes is the source of transmission of the bacteria during sexual contact or during
passsge of a new born through the birth canal.
• The site of infection relates to the type of sexual contact occuring in the mouth and throat after oral- genital contact, vagina and
penis after genital contact or rectum after recto - genital contact.
• inflammation of the Urethra with pus
• painful urination
• Inflammation of prostate gland and epididymis.
• Infection in vagina
• Discharge of pus
• In females, the infection and consequent inflmammation can proceed from the vagina into the Uterus, uterine tubes, and pelvic
cavity.
• Peritonitis or inflmammation of the Peritoneum, is a life threatening disorder. If the bacteria are transmitted to the eyes of
newborn in the birth canal, blindness can result.
• Administration of 1% silver nitrate solution in the infant’s eyes prevents infections.
• Penicillin and Tetracycline was choice of treatment of gonnorroea in adults.
• Ceftriaxone is the antibiotic that most effectively attacks the majority of Gonorrhoeae bacteria.
Males
Females

41. GONORRHOEA

42. SYPHILIS
• Syphilis is a sexually transmitted disease caused by the bacterium Treponema
pallidum.
• It is transmited through sexual contact or exchange of blood or through the placenta to
a fetus.
• The disease progresses through several stages. During the primary stage, the chief
symptom is painless open sore called a chancre, at the point of contact. The chancre
heals within 1-5 weeks.
• From 6 to 24 weeks later, symptoms such as skin rash, fever and aches in the joints in
the secondary stage.These symptoms also eventually disappear (in about 4-12 weeks)
and the disease ceases to be infectious, but a blood test for the presence of the
bacteriagenerally remains positive.
• During this “symptomless” period called the latent stage, which may last up to 20 years,
the bacteria may invadebody organs. When signs of organ degeneration appear, the

43. • If the organs of the nervous system become involved, the tertiary stage is called
neurosyphilis. Neurosyphilis may take different forms, depending on the tissue
involved.
• Cerebellar damage is manifested by uncoordinated movements in activities such
as writing. As the motor areas become extensively damaged, victims may be
unable to control urine and bowel movements. Eventually, they may become
bedridden, unable even to feed themselves.
• Damage to the cerebral cortex produces memory loss and personality changes that
range from iritability to hallucinations. AIDS and other disorders that compromise
the immune system may speed the progression of neurosyphilis, possibly by
impairing macrophages and antibody production.
• Syphilis can be treated with antibiotics (penicillin) during the primary, secondary
and latent periods. Certain forms of neurosyphilis may also be successfully treated,
but the prognosis for others is very poor.
SYPHILIS

44. • Caused By – Treponema pallidum
SYPHILIS
1° Stage (Heals in 1-5 weeks)
• Painless Chancre
2° Stage (lasts upto 4-12 weeks)
• Skin Rashes
• Headache & Fever
• Ache in Joints
Latent Stage (Lasts upto 20 year)
• Symptom less Period
Tertiary Stage
• Degeneration of organs
starts appearing
2° Tertiary Stage
• Cerebellar Damage
• Unable to control Urine

45. SYPHILIS

46. CHANCROID
• Chancroid is a sexually transmitted disease caused by the short gram -ve
bacillus Haemophilus ducrei.
• The incubation period is 3-5.days.
• The initial lesion at the site of inoculation breaks down to form a painful,
ulcer with a necrotic base. With lymph node involvement, fever and chills
may occur.
• Women may have no external signs of infections.
• Chancroid must be differentiated from other genital ulcers.
• The chancre of syphilis, by contrast, is clean and painless, with a hard base.
• A single dose of either azithromycin or ceftriaxone given
intramuscularly is effective.

47. GENITAL HERPES
• Type Il herpes simplex virus(HSV-2) causes genital
infections, such as painful genital blisters on the prepuce,
glans penis and penile shaft in males and on the vulva or
sometimes high up in the vagina in females.
• The blisters disappear and reappear in most patients, but the
virus itself remains in the body. A related virus, Type I
herpes simplex virus (HSV-1), causes cold sores on the
mouth and lips. Infected persons ypIcaily experience
recurrences of symptoms several times a year.
• Treatment of the symptoms involves pain killer medication,
saline compresses, sexual abstinence for the duration of the
eruption, and use of oral drug called Acyclovir (Zovirax).
• This drug interferes with viral DNA replication but not with
host cell DNA replication.
• Acyclovir speeds the healing and sometimes reduces the
pain of initial genital herpes infections.

48. GENITAL WARTS
• Warts are infectious disease caused by viruses.
• Sexual transmission of genital warts is common
and is caused by Human Papilloma Virus (HPV).
• Patients with a history of genital warts may be
at increased risk for cervical, vaginal, anal, vulval
and penile cancers.
• Treatment consist of cryotherapy with liquid
nitrogen, electriocautery, excision, laser surgery
and topical application of podophyllin in
tincture of benzoin.
• Alpha – interferon is also used to treat genital
warts.
• PAP smear is done as screening test for cervical
cancer.

49. ACQUIRED IMMUNO DEFICIENCY SYNDROME
(AIDS)
• AIDS is caused by Human Immunodeficiency Virus (HIV).
• HIV can get transmitted through blood and also by sexual contact
between males and females through vaginal, oral or anal
intercourse.
• Male homosexuals transmit HIV to thier partner by anal or oral
intercourse.
• HIV enters body cell by CD4 Receptor- mediated endocytosis
involving T4 cells. With time, the number of T4 cells, mainly
helper T cells, declines due to death of infected cells.
• The result is progressive collapse of the immune system and the
person becomes susceptible to opportunistic infections (invasion
of normally harmless micro-organisms that now proliferate widely
because of the defective immune system).
• The first and still most commonly used drug to treat AIDS is AZT
(azidothymidine) or, Retrovir(Other drugs are DDI
(Dedeoxyinosine), DDC (dedeoxycytidine) and D4T (stavudine) or

50. TRICHOMONIASIS
• The microorganism Trichomonas vaginalis, a
flagellated protozoan, causes Trichomoniasis.
• An inflmammation of the mucous membrane of
the vagina in female and urethra in males where
it is common inhabitant.
• If the normal acidity of the vagina is disrupted,
the protozoan may overgrow the normal
microbial population and cause Trichomoniasis.
• Symptom include: yellow vaginal discharge with
a particularly offensive odour and severe vaginal
itch.
• The drug of choice is metronidazole.

51. SOME COMMON TECHNIQUES FOR
INDENTIFICATION OF STD
Sexually Transmitted
Diseases
Causitive Agent Detection Techniques
CHLAMYDIA Chlamydia trachomatis
Clinical, Gram-staining of
discharge, antigen detection,
nucleic acid hybridisation
GONORRHOEA Neisseria gonorrhoea
Gram-staining of discharge,
culture
TRICHOMONIASIS Trichomoniasis vaginalis
Microscopic examination,
culture
GENITAL HERPES
Type II herpes simplex
(HSV-2)
Clinical, antigen test, PCR
SYPHILIS Treponema pallidum
Antibody detection, e.g.,
VDRL
( Venereal Disease Research
Laboratory)
CHANCROID Haemophilus ducrei Clinical, culture
GENITAL WARTS
Human Papilloma Virus
(HPV)
Clinical, antibody detection,
culture, DNA hybridisation

52. INFERTILITY
• Infertility is the failure to conceive even after 1- 2 years of regular,
unprotected sex.
• The term is not synonymous with sterility; which means complete
inability to produce offspring.
• Infertility can best be defined, as relative sterility.
• It is of two types – Primary and secondary.
• Primary infertility is the infertility found in patients who have
never conceived.
• Secondary infertility is found in patients who have previously
conceived.
• Infertility can be caused by defects found in males or females ..

53. • Semen of a fertile male is 2.5 to 5 ml per ejaculation with a sperm count of
over 200-300 million, mostly motile, having proper fructose content and
fluidity which is deposited high in the vagina.
• Any defect in sperm count, sperm, structure, sperm motility of seminal fluid
leads to infertility.
• Low sperm count is called oligospermia.
• Absence of sperm is known as azoospermia.
• Low sperm motility is called asthenozoospermia.
• Defective sperm morphology is termed as teratozoospermia.
INFERTILITY IN MALES

54. 1. Cryptorchidism or failure of testes to descend into scrotum.
2. Absence or blockage of Vasa efferentia.
3. Hyperthermia or higher scrotal temperature due to varicocele (varicose veins), hydrocele or filariasis,
tight undergarment, thermal undergarment or working in hot environment cause oligospermia or
depressed spermatogenesis.
4. Infections like mumps after puberty (orchitis or inflammation of testes), bronchiectasis (chronic dilation
of bronchioles), infection of seminal vesicles or prostate result in oligospermia. Infections of Chlamydia
trachomatis also cause oligospermia.
5. Alcoholism inhibits spermatogenesis.
6. Klinefelter’s Syndrome.
7. Gonadotropin Deficiency.
8. Cytotoxic drugs, radiations, antidepressants and anticonvulsant drugs suppress Spermatogenesis.
9. Low fructose content, high prostaglandin content, high viscosity and low volume of ejaculate lead to
male infertility.
INFERTILITY IN MALES

55. A fertile woman is the one who regularly ovulates once every cycle, passes the egg
down the reproductive tract which develops conditions for smooth passage of
sperms and implantation of fertilised egg.
The various causes of infertility in females are as follows :
INFERTILITY IN FEMALES
1. Anovulation(nonovulation)and oligoovulation(deficient
ovulation) are caused by deficient functioning of
hypothalamo-pituitary complex or secondarily by thyroid
and adrenal dysfunction.
2. Defect in cervix like congenital elongation, occlusion of
cervix by a polyp, cervicitis, scanty or excessive Cervical
mucus and presence of antisperm antibodies
3. The ovum is not liberated but remains trapped inside the
follicle due to hyperprolactinaemia.
4. Defective vaginal growth
5. Noncanalisation of Uterus
1. 6. Defective uterine endometrium due to reduced or
excessive secretory activity.
2. Congenital malformation of uterus.
3. Fibroid uterus.
4. Inadequate growth and functioning of corpus luteum
resulting in reduced progesterone secretion and deficient
secretory changes in endometrium. It is called luteal
phase defect. It inhibits implantation.
5. Fallopian tube may fail to pick up ovum, have impaired
motility, loss of cilia and blocked lumen. The defects may
be caused by infection or endometriosis.

56. INFERTILITY IN FEMALES

57. ASSISTED REPRODUCTIVE TECHNOLOGIES
(ART)
• More than two decades ago, in an experimental procedure called In
vitro fertilization(IVF), doctors joined a woman’s egg and a man’s
sperm in a glass dish in a laboratory.For the first time,
fertilisationhappened outside a woman’s body. Nine months later, the
first test-tube baby was born.
• 1st Test tube baby borned in England, 25/07/1978 Louis Joy
Brown
• 1st Test tube baby borned in India, 03/10/1978 – Durga a.k.a
Kanupriya Agarwal
• Today, Assisted ReproductiveTechnology(ART) refers not only to IVF
but also to several variations tailoredto patient’s
uniqueconditions.These procedures are usually paired with more
conventional therapies, such as fertility drugs, to increase success
rates. Almost one out of every three cycles of ART results in the birth
of a baby.
• But ART procedures are invasive and expensive. Though no long-term
health effects have been linked to chldren born using ART procedures,

58. MAIN ART TECHNIQUES
• In vitro fertilization (IVF): This is one of the most
commonly used procedures. Eggs are combined with
patner’s sperm in a dish in a laboratory. Once
fertilization has occurred, the resulting embryos
develop for 3 to 5 days before being placed in uterus.
• Intracytoplasmic sperm injection (ICSI): One of the
partner’s sperms is placed inside the egg with a
microscopic needle, rather than many sperms
positioned close to the outside of the egg as in IVF in
a dish in a lab. Once fertilization occurs, the resulting
embryo is placed in uterus.
• Gamete intrafallopian transfer (GIFT) : Transfer of
an ovum collected from a donor into the
fallopiantube (GIFT) of another female who cannot
produce one, but can provide suitable environment
for fertilisation and further development.
• Donor egg or embryo : If one is unable to
conceive using her own eggs, an egg donated by
another womanis mixed with partner’s sperms and
the resulting embryo Is implanted in the uterus.
This procedure can also be done with a donated
embryo or sperm.
• Artificial Insemination(AI) : If the infertility of
male is either due to inability of male partner to
achieve an erection of penis to inseminate the
female or due to very low sperm count in the
semen, it is corrected by Al.
• In AI The semen collected either from the husband
or a healthy donor is artificially introduced either
into the vagina or into the uterus (IU –intrauterine
insemination) of the female.

59. • Surrogacy or use of a gestational carrier: Another woman
carries embryo or a donor embro to term.
• Zygote intrafallopian transfer (ZIFT): In test-tube baby
programme, ova from the wife/donor (female) and sperms from
the husband/donor (male) are collected and are induced to form
zygote under simulated conditions in the laboratory.The zygote
or early embryo (with upto 8 blastomeres)could then be
transferred intothefallopian tube(ZIFT) andembryos
withmorethan8 blastomeresinto the uterus 4. (IUT-Intra-Uterine
Transfer)to complete its further development.
MAIN ART TECHNIQUES