Reproductive health Class 12 CBSE

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. High birth rate but fluctuating death rate, Declining death rate and continuing high birth rate, Declining birth rate and death rate, 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

9. 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.

10. 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 the number of births and that of deaths is called the rate of natural increase . If birth and death rates were equal a zero population growth rate would result which is known as demographic transition . It has occurred in most developed countries. Human Population growth

11. 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.

12. Age and sex structure Age-sex pyramids between 1975 and 2000 – Developed Countries Age-sex pyramids between 1975 and 2000 – Developing Countries

13. Types of Contraceptives

14. 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 : User friendly i.e, comfortable and easy to use. Absence of side effects Reversible i.e, when the user wants to conceive, it should be easy to interrupted. Completely effective against pregnancy. Cheap in cost Easily available Should not disturb normal sexual desire

15. 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

16. 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

17. 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.

18. 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.

19. 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. The device also absorbs ejaculate.

20. 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.

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

22. 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. I t has high co ntraceptive value and a very little side effects . “ Saheli ” co ntraceptive pill has been developed at CENTRAL DRUG RESEARCH INSTITUTE, LUCKNOW

23. 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

24. 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).

25. 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.

26. 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.

27. 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.

28. Surgical Method of Contraception

29. Surgical Method of Contraception

30. Surgical Method of Contraception VASECTOMY TUBECTOMY

31. Induced Abortion Abortion refers to the premature expulsion of the conception products from the uterus, usually before 20 th 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.

32. 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.

33. 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)

34. 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.

35. 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

36. 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 ad ministration of Tetracycline or Doxycycline Males Females Chlamydia

37. Chlamydia

38. 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

39. GONORRHOEA

40. 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 disease is said to be in tertiary stage.

41. 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

42. 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

43. Syphilis

44. 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.

45. 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.

46. 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.

47. 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 CD 4 Receptor- mediated endocytosis involving T 4 cells. With time, the number of T 4 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 Zerit.

48. 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.

49. 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 virus (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

50. 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 ..

51. 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

52. Cryptorchidism or failure of testes to descend into scrotum. Absence or blockage of Vasa efferentia. 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. 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. Alcoholism inhibits spermatogenesis. Klinefelter’s Syndrome. Gonadotropin Deficiency. Cytotoxic drugs, radiations, antidepressants and anticonvulsant drugs suppress Spermatogenesis. Low fructose content, high prostaglandin content, high viscosity and low volume of ejaculate lead to male infertility. Infertility in males

53. 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 Anovulation (nonovulation)and oligoovulation (deficient ovulation) are caused by deficient functioning of hypothalamo-pituitary complex or secondarily by thyroid and adrenal dysfunction. Defect in cervix like congenital elongation, occlusion of cervix by a polyp, cervicitis, scanty or excessive Cervical mucus and presence of antisperm antibodies The ovum is not liberated but remains trapped inside the follicle due to hyperprolactinaemia. Defective vaginal growth Noncanalisation of Uterus 6. Defective uterine endometrium due to reduced or excessive secretory activity. Congenital malformation of uterus. Fibroid uterus. 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. 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.

54. Infertility in females

55. 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. 1 st Test tube baby borned in England, 25/07/1978 Louis Joy Brown 1 st 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, most doctors recommend reserving ART as a last resort for having a baby.

56. 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.

57. 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