Infertility

Infertility is a problem for 15% to 30% of couples. Male infertility may be
a result of insufficient numbers of sperm and/or poor motility. Normally, the
ejaculate has a volume of 3 to 4 ml, with approximately 100 million sperm
per ml. Males with 20 million sperm per ml or 50 million sperm per total
ejaculate are usually fertile. Infertility in a woman may be due to a number of
causes, including occluded oviducts (most commonly caused by pelvic inflammatory
disease), hostile cervical mucus, immunity to spermatozoa, absence
of ovulation, and others.
In vitro fertilization (IVF) of human ova and embryo transfer is a frequent
practice conducted by laboratories throughout the world. Follicle growth in the
ovary is stimulated by administration of gonadotropins. Oocytes are recovered
by laparoscopy from ovarian follicles with an aspirator just before ovulation
when the oocyte is in the late stages of the first meiotic division. The egg is
placed in a simple culture medium and sperm are added immediately. Fertilized
eggs are monitored to the eight-cell stage and then placed in the uterus
to develop to term. Fortunately, because preimplantation-stage embryos are
resistant to teratogenic insult, the risk of producing malformed offspring by
in vitro procedures is low.
A disadvantage of IVF is its low success rate; only 20% of fertilized ova
implant and develop to term. Therefore, to increase chances of a successful
pregnancy, four or five ova are collected, fertilized, and placed in the uterus.
This approach sometimes leads to multiple births.
Another technique, gamete intrafallopian transfer (GIFT), introduces
oocytes and sperm into the ampulla of the fallopian (uterine) tube, where
42 Part One: General Embryology
fertilization takes place. Development then proceeds in a normal fashion. In a
similar approach, zygote intrafallopian transfer (ZIFT), fertilized oocytes are
placed in the ampullary region. Both of these methods require patent uterine
tubes.
Severe male infertility, in which the ejaculate contains very few live sperm
(oligozoospermia) or even no live sperm (azoospermia), can be overcome
using intracytoplasmic sperm injection (ICSI). With this technique, a single
sperm, which may be obtained from any point in the male reproductive tract,
is injected into the cytoplasm of the egg to cause fertilization. This approach
offers couples an alternative to using donor sperm for IVF. The technique
carries an increased risk for fetuses to have Y chromosome deletions but no
other chromosomal abnormalities.