Question

Placed below are case studies of some couples who were not able to have kids. These couples are not ready for adoption or taking gametes from donors. After thoroughly examining the cases, which Assisted Reproductive Technology will you suggest to these couples as a medical expert? Explain briefly with justification of each case.

Couple	Test reports of Female partner	Test reports of male partner
Couple 1	Normal reports	Normal sperms in testes, Missing connection in epididymis and Vas deferens.
Couple 2	Blockage in the fallopian tube	Normal reports
Couple 3	Normal reports	Poor semen parameters in terms of count, motility and morphology.
Couple 4	low ovarian reserve	Normal reports
Couple 5	Sterilization in male	Morphologically abnormal sperms

Answer 1

• Couple 1: Normal reports of females, Normal sperms in testes, Missing connection in epididymis and Vas deferens in males.
  Assisted Reproductive Technology:
  Semen will be devoid of sperms in this case. So, In-vitro fertilization (IVF) by collecting the sperms from epididymis, followed by ZIFT or IUT (Test Tube Baby) is suggested. ZIFT is the transfer of zygote or early embryo up to 8 blastomeres in fallopian tube and IUT refers to transfer of embryos with more than eight blastomeres in uterus.
• Couple 2: Blockage in the fallopian tube in the female. Regular reports of males.
  Assisted reproductive Technology:
  Blockage of the Fallopian Tube will not allow transfer of sperm to the site of fertilisation. In-vitro fertilization (IVF) followed by IUT (Test Tube Baby). It would involve transfer of an embryo with more than eight blastomeres in uterus.
• Couple 3: Normal reports of female, Poor semen parameters in terms of count, motility and morphology in male partner.
  Assisted Reproductive Technology:
  Intracytoplasmic sperm injection (ICSI) in which sperm is directly injected into the ovum. Artificial insemination is used mainly when sperm have poor characteristics or low sperm count.
• Couple 4: Low ovarian reserve in females, Normal reports in males.
  Assisted Reproductive Technology:
  In-vitro-fertilization (IVF) by selection of normal blastocysts from the ovary followed by Zygote intrafallopian transfer involving transfer of zygote or early embryos up to 8 blastomeres (ZIFT) or transfer of embryo with more than eight blastomeres in the uterus (IUT).
• Couple 5: Poor ovarian reserve in females, morphologically abnormal sperms in male partners.
  Assisted Reproductive Technology:
  ICSI intracytoplasmic sperm injection in which selected normal sperms will be injected into the chosen blastocyst. Intracytoplasmic sperm injection (ICSI) procedure is used mainly when sperms have poor characteristics or low sperm count.