ICSI = Intracytoplasmic Sperm Injection
ART technique: single sperm injected directly into egg cytoplasm using micropipette
Used for: severe male infertility (low count, poor motility, abnormal morphology)
Bypasses: zona pellucida + oocyte membrane
Answer: Intracytoplasmic Sperm Injection
ART encompasses all procedures involving manipulation of eggs, sperm, or embryos outside the body to achieve pregnancy. Louise Brown (1978, UK) = world's first IVF baby ("test-tube baby"). ART usage: ~3-5% of all births in developed countries. India has one of the largest ART industries globally. Types: AIH/IUI (least invasive), IVF, ICSI (most invasive). Success rates: ~30-40% live birth rate per cycle for women under 35 (decreases with age).
Normal semen analysis (WHO 2021 criteria): Volume >1.4 mL, Concentration >16 million/mL, Total count >39 million, Motility (progressive) >30%, Morphology (normal forms) >4%. Causes of male infertility: Oligospermia (<16M/mL), Azoospermia (no sperm), Asthenospermia (poor motility), Teratospermia (>96% abnormal). Treatment: lifestyle changes (obesity, smoking, alcohol), hormonal treatment, surgical repair (varicocele), ART (IUI, ICSI).
ART raises ethical questions: Multiple embryo transfer → multiple pregnancies → premature births, developmental problems. Embryo selection and disposal. PGT (preimplantation genetic testing): screening embryos for genetic disorders before transfer — ethical concerns about "designer babies." Surrogacy regulations vary by country. India had a surrogacy industry but enacted Surrogacy Regulation Act 2021 (altruistic surrogacy only for close relatives). Donor anonymity issues.
ICSI fertilisation rate: 70-80% of injected eggs fertilise. Clinical pregnancy rates: similar to conventional IVF per embryo transferred. Limitations: requires egg retrieval (ovarian stimulation). May carry slightly higher risk of imprinting disorders (though absolute risk is small). Does not solve all infertility causes. Cannot treat poor egg quality. Cost: expensive, not universally covered by insurance.
IVF, or in vitro fertilisation, fertilises ova outside the body and transfers the resulting embryo. If the embryo has up to eight blastomeres the transfer is called ZIFT, into the fallopian tube; beyond that stage it is IUT, into the uterus. GIFT transfers an ovum from a donor directly into the fallopian tube of a woman who cannot produce ova but can support fertilisation. ICSI injects a single sperm directly into an ovum, used when sperm count or motility is the problem.
The technique follows the specific defect. Blocked fallopian tubes call for IVF with uterine transfer. Very low sperm count calls for ICSI. Inability to produce ova calls for GIFT. Inability of the male partner to inseminate calls for artificial insemination, either AI with the husband's semen or IUI, in which semen is placed directly in the uterus. Exam questions on ART are almost always of this matching form.
Despite the technology being available, very few infertile couples use it. The reasons are as much social as medical: high cost, limited availability outside major cities, emotional and physical demands of the procedure, and social stigma attached to infertility. NCERT also raises adoption as an important alternative, given the number of children needing care — a point worth including in any long-answer question on this topic.
Mixing up ZIFT and IUT. Both transfer an embryo, but ZIFT goes into the fallopian tube at the early stage and IUT into the uterus at a later stage.
Confusing GIFT with IVF. GIFT transfers an unfertilised ovum into a fallopian tube; fertilisation then happens inside the body, not in a dish.