Infertility and assisted reproduction

Infertility is the inability to have children despite unprotected sexual relations. Its causes are many: physical, congenital (present from birth), diseases, drugs, immunological, or even psychological. In India, the woman is often blamed, but the problem lies quite often in the male partner.

Special health centres can find the cause and treat it. Where treatment cannot correct it, assisted reproductive technologies (ART) can help:

• IVF-ET (in vitro fertilisation and embryo transfer), the 'test tube baby' method. Ova from the wife or a donor and sperms from the husband or a donor are brought together outside the body, in the laboratory, to form a zygote. The zygote or early embryo is then placed in the mother: an embryo of up to 8 blastomeres goes into the fallopian tube (ZIFT, zygote intra-fallopian transfer); one with more than 8 goes into the uterus (IUT, intra-uterine transfer).
• Embryos made inside a female can also be moved to another female for further development.
• 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 the right conditions for fertilisation and development.
• ICSI (intra-cytoplasmic sperm injection): a sperm is injected directly into the ovum in the laboratory.
• Artificial insemination (AI): semen from the husband or a donor is put into the vagina, or into the uterus (IUI, intra-uterine insemination). It helps when the male cannot inseminate the female or has a very low sperm count.

These methods need very skilled people and expensive equipment, so they are available only in a few centres, and there are also emotional, religious and social questions around them. Legal adoption is one of the best ways for couples who want to become parents: it also gives a home to a child who needs one.