RAM DAYAL

Embryologist

What is Infertility?
Inability to conceive a baby after one year of

unprotected intercourse.
Affects the reproductive organs of both men and
women.
Infertility affects about 15% of couples in the United
States.

Infertility
Requirements for a successful conception:
A healthy sperm and a healthy egg unite to form a

zygote
Place for fertilization to occur (a fallopian tube)
Place for the fetus to grow (a uterus)

Causes of Infertility in Males

Low sperm count
Low sperm motility
Impotence including erectile

dysfunction
Aspermia

Other Causes of Infertility in

Females
Secondary amenorrhea
Fallopian tube blockage

Other Factors Influence Fertility

Personal habits
Environmental factors
Age associated with decreased fertility and increased

risk of chromosomal abnormality

Sexually transmitted diseases
Social factors

Age and Infertility

Causes of Infertility in Women

Most Common Choices of Treatment

In Vitro Fertilization

Artificial Insemination
Frozen Embryos
Gamete Intra Fallopian

Transfer
Zygote Intra Fallopian
Transfer

Methods of Assisted Reproduction

In vitro fertilization (IVF)
Gametes are collected and fertilized in a dish
The resulting zygote is implanted in the uterus
Gamete intrafallopian transfer (GIFT)
Gametes are collected and placed into a womans
oviduct
Intracytoplasmic sperm injection (ICSI)
An egg is fertilized by microinjection of a single sperm
(for defects in sperm count or motility)

IVF (in vitro fertilization) is a method in

which egg cells are fertilized by sperm
cells outside the mothers womb (in
vitro). The resulting embryos are then
transferred back into the uterus.

Oocyte at Ovulation
2 oocyte arrested in Metaphase II

Completion of Meiosis only if fertilization

occurs
Follicular cells of corona radiata protect
ovum as it breaks through ovary wall

Basic Principle of IVF

Hormonal
treatment
Female
Harvest
the ovum
Mature Ova

Mix in a test tube

Motile sperms

Keep to
develop
embryo

Collect semen

Natural
ejaculation

Male

Transfer
to mother

Oocytes with
granulosa cells

"Naked" Oocyte

Fertilization:
the fusion of the sperm cell nucleus
with the egg cell nucleus to
produce a zygote (fertilized egg)

Fertilization
Taking place in ??

Viability of gametes:
Oocyte 12-24 h
Sperm 12-48 h

acrosomal
reaction breaks down intercellular cement between
adjacent follicle cells

Acrosome contains hyaluronidase

Single sperm fuses with oocyte

amphimixis - fusion of sperm and oocyte pronuclei

Sperm parts
Acrosome
tail
Egg parts
Corona radiata

zona pellucida
Plasma membrane

Polyspermy prevented by a
change in the zone pellucida
membrane charge as one
sperm enters

Fusion of the pronuclei:

(in vitro)

The male and female

pronuclei are
indistinguishable from one
another.
The second polar body can
be seen (arrow).
The plasma membranes of
the two pronuclei are
dissolving and one diploid
nucleus will remain.
Advanced Fertility Center of Chicago
http://www.advancedfertility.com/

Stage of fertilization:
Membranes of the pronuclei break down,

chromosomes condense and arrange themselves for

mitotic cell division
On membrane dissolution, there is 1 cell with 46

chromosomes = diploid (2N)

The first cleavage follows shortly, leaving 2 cells, each
with 46 chromosomes.

Mitosis in the new zygote uses centrioles derived from the

sperm. The oocyte has no centrioles.

Fertilization facts:

Completed within 24 hours of ovulation

Approximately 400 to 600 MILLION sperms are

deposited at cervical opening during ejaculation.
Some sperm are held up by the folds of the cervix and are

gradually released into the cervical canal; this gradual

release increases the chances of fertilization.
Most human sperms do not survive longer than 48 hours in
the female genital tract.

Only about 200 sperms reach the fertilization site;

most degenerate and are absorbed by the female

genital tract.

The
results
of
fertilization:
Stimulates the secondary oocyte to complete meiosis.
Restores the normal diploid number of chromosomes
(46).
Results in variation of human species as maternal and
paternal chromosomes intermingle.
The embryo contains only maternal mitochondria

because the sperm mitochondria are dispersed into

the egg cytoplasm and discarded.
Determines the sex of the embryo.
The sex chromosome (Y or X) carried by the successful

sperm determines embryonic sex.

Twins:
still
1
sperm
per
egg
Monozygotic (monoovular):
A fertilized, single egg splits into two developing zygotes at

a very early stage.

Identical twins; same sex.

Dizygotic (polyovular):
Result from the fertilization by two sperm of two separate
ova that have reached maturation at the same time.
Not identical twins; can be different sexes
Incidence increases with age of the mother

HIGH QUALITY THREE DAY OLD EMBRYO

Intrauterine Insemination (IUI)

In intrauterine
insemination (IUI), donor
sperm is placed into the
uterus of an ovulating
woman. The sperm swim
up the oviduct and
fertilize the egg.

Fertilization to implantation:
Know where this happens.

Gamete Intrafallopian Transfer

(GIFT)

Fig. 16-9a, p. 360

Zygote Intrafallopian Transfer (ZIFT)

Fig. 16-9, p. 360

Implantation:
After 6 days the blastocyst
imbeds into the
endometrium. Usually on
the high back wall of the
uterus

How can fertilization go awry?

Too many sperm = dispermy or triploidy
Leads to spontaneous abortion in most cases.
Infertility
Bad timing:
The sperm can only survive 48 hours within the female
genital tract.
In vitro studies show the ovulated egg cannot be fertilized
after 24 hours.

Triploidy

(in vitro)

There are 3 pronuclei

within this one
zygote. In the
laboratory, such
embryos are
discarded. In vivo,
such embryos almost
always abort
spontaneously.

Advanced Fertility Center of Chicago

http://www.advancedfertility.com/

Use of ART Carries Risks

to Parents and Children
Risks of ART
Threefold increase in ectopic pregnancies
Multiple births (35% in IVF)
Increased risk of low birth weight
Increased risk of transmitting genetic defects to male
children (in ICSI)

Surrogacy is another form of ART

Fig. 16-10, p. 361

IVF has Resulted in the Birth of

Millions of Children

Fig. 16-7, p. 359

Thank you