Infertility: inability to conceive despite regular unprotected sexual intercourse for at least 12 months. Affects approximately 15-20% of couples worldwide. Causes in females: blocked fallopian tubes, endometriosis, ovulatory disorders, polycystic ovary syndrome (PCOS), uterine fibroids, premature ovarian failure, hormonal imbalances. Causes in males: low sperm count (oligospermia), poor sperm motility (asthenospermia), abnormal sperm morphology (teratospermia), azoospermia (no sperm), varicocele, hormonal imbalances. Combined factor infertility: both male and female factors. Unexplained infertility: no cause found despite thorough investigation (~25% of cases). ART (Assisted Reproductive Technologies): medical procedures to help infertile couples achieve pregnancy.

GIFT was developed by Ricardo Asch in 1984. Procedure: (1) Ovarian stimulation: fertility drugs (gonadotropins) administered to female donor to stimulate multiple follicle development. (2) Egg retrieval: mature oocytes collected by transvaginal ultrasound-guided aspiration. (3) Sperm collection: from male partner or donor, washed and prepared. (4) Transfer: eggs (oocytes) and prepared sperm mixed together → immediately loaded into catheter → transferred into the fallopian tube via laparoscopy. (5) Fertilisation: occurs naturally in the fallopian tube in vivo. (6) The resulting embryo travels naturally down the fallopian tube to the uterus for implantation. Indication: used when female cannot produce her own oocytes but has functional fallopian tube. Or unexplained infertility where fallopian tube function is normal. Advantage over IVF: fertilisation occurs in natural environment. Limitation: requires functional fallopian tubes (cannot be used if tubes blocked or absent).

IVF (In Vitro Fertilisation) + ET (Embryo Transfer): most common ART. First successful IVF baby: Louise Brown (born July 25, 1978, UK). Developed by Patrick Steptoe and Robert Edwards (Nobel Prize 2010 to Edwards). Procedure: (1) Controlled ovarian hyperstimulation (COH): daily gonadotropin injections for 8-12 days → multiple follicles develop. (2) Egg retrieval: transvaginal ultrasound-guided aspiration (usually under sedation). 8-15 eggs typically collected. (3) Sperm collection and preparation: swim-up or density gradient. (4) Insemination: eggs and 50,000-100,000 sperm mixed in culture dish → fertilisation in vitro. (5) Embryo culture: 3-5 days in incubator. (6) Embryo transfer: 1-2 embryos transferred into uterus via catheter through cervix. (7) Luteal support: progesterone supplements. (8) Pregnancy test after 12-14 days. Success rate: 30-40% per cycle depending on age.

ZIFT (Zygote Intrafallopian Transfer): similar to IVF but zygote (fertilised egg, day 1 embryo) transferred to FALLOPIAN TUBE (not uterus). Combines IVF fertilisation with intrafallopian transfer. Requires functional fallopian tube. Less commonly used than IVF-ET. ICSI (Intracytoplasmic Sperm Injection): single sperm injected directly into egg cytoplasm. Used for severe male factor infertility (very low sperm count, poor motility, azoospermia with surgically retrieved sperm). Dramatically improved outcomes for male infertility. IUI (Intrauterine Insemination): prepared sperm (washed, concentrated) directly injected into uterine cavity around time of ovulation. Simpler and cheaper than IVF. Used for: mild male factor, cervical factor, unexplained infertility. Surrogacy: embryo from couple (or donor egg/sperm) implanted in surrogate mother's uterus. Gestational surrogacy: surrogate has no genetic connection to child. Traditional surrogacy: surrogate's own egg used.

Contraception (birth control): methods to prevent unwanted pregnancy. Natural methods: Periodic abstinence (rhythm/calendar method): avoid sex during fertile days. Coitus interruptus (withdrawal): unreliable. Lactational amenorrhoea: breastfeeding suppresses ovulation. Barrier methods: prevent sperm reaching egg. Condom (male: latex, female: polyurethane). Diaphragm: rubber dome covers cervix. Cervical cap. Hormonal methods: Oral contraceptive pills (OCP): combined oestrogen + progesterone → suppress ovulation. Injectable: medroxyprogesterone acetate (Depo-Provera). Implants: subdermal rods releasing progestin. Emergency contraception (i-pills): levonorgestrel/ulipristal within 72-120 hours. IUDs (Intrauterine Devices): Copper IUDs (CuT-380A, Multiload-375): copper ions are spermicidal. Hormonal IUDs (Mirena, Progestasert): release progestogen → thicken cervical mucus. Surgical: Vasectomy (male): vas deferens cut/tied. Tubectomy (female): fallopian tubes cut/tied/blocked. Permanent.

Key contraceptive devices and their classifications: Progestasert: IUD that releases progesterone locally into uterine cavity. Classified as hormone-releasing IUD. Multiload-375 (ML-375): copper-releasing IUD with 375 mm² of copper wire wound around vertical stem. Classified as copper-releasing IUD. Diaphragm: dome-shaped rubber/silicone device placed over cervix before intercourse. Barrier method. Saheli: once-a-week oral contraceptive pill developed by CDRI (Central Drug Research Institute), Lucknow, India. Contains centchroman (ormeloxifene) — non-steroidal anti-oestrogen. First once-weekly oral contraceptive. No oestrogen side effects. Classified as oral contraceptive (non-steroidal). These classifications are important for Q147 of this NEET paper (Progestasert=hormone-releasing IUD, Multiload-375=copper IUD, Diaphragm=barrier, Saheli=oral).

PGD (Pre-implantation Genetic Diagnosis): genetic testing of embryos created by IVF before they are transferred to the uterus. Procedure: IVF → embryo grown to blastocyst (day 5-6) → 1-2 cells biopsied from embryo → genetic testing → only unaffected embryos transferred. Tests: chromosomal abnormalities (PGD-A = aneuploidy screening): screens for aneuploid embryos (trisomies etc.) → transfers only euploid (chromosomally normal) embryos → improves IVF success. Single gene disorders: HLA matching (to produce a sibling who can be a stem cell donor), BRCA1/2 mutations, sickle cell, cystic fibrosis. Applications: couples at risk of passing genetic disease to children, women with recurrent miscarriage, advanced maternal age. Ethical issues: potential for sex selection, "designer babies," disposal of embryos with genetic disorders.

India: one of the world's largest markets for IVF and surrogacy. ART (Regulation) Act 2021: regulates clinics and banks offering ART services. Surrogacy (Regulation) Act 2021: bans commercial surrogacy (where surrogate is paid beyond medical expenses). Allows altruistic surrogacy (by close female relatives of commissioning couple). Eligibility: married heterosexual couples who are medically certified to need surrogacy. WHO defines reproductive rights: right to decide on having children, access to family planning methods, freedom from reproductive coercion. MTP (Medical Termination of Pregnancy) Act 1971 (amended 2021): allows safe legal abortion in India up to 20 weeks (up to 24 weeks with medical board approval in specific cases). Reduces unsafe abortions. Government programmes: promoting awareness of contraception and family planning. STI prevention. Reproductive health education.