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they were unable to conceive for more than 5 years and need assisted reproductive therapy (ART)

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What causes the infertility?

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which types of ART is the best for the couple to help them conceive?

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Which parent is having fertility issues or is it both

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Are there any underlying diseases that can cause infertility?

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Infertility - not being able to conceive after having unprotected sex for a year.
Couples can use assisted reproductive methods such as IVF to help them conceive.
Either the man or the woman is infertile.
Fertilisation - fusion of sex gametes from male and female, leading to a formation of zygote.

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why is ZIFT prefered over IVF? and why does it have higher pregnancy and implantation rates higher?

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1. Preparation of sperm
- capacitation

2. Sperm-egg binding
- acrosome reaction

3. Sperm-egg fusion
- fertilin

4. Egg activation
- cortical reaction

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Processes that need to occur for successful fertilization

-        Sperm – zona binding

-        Acrosome reaction

-        Sperm egg fusion

-        Egg activation

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How does ART help to fertilize Elise's eggs?

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Is there a case where Andrew's sperm are too "weak" to fertilise the ova

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What caused their infertility? Genetic?
What is the most suitable assisted reproductive method to help them conceive?

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Find out what kind of fertilty issues theyre facing and from there the most efficient assited reproductive therapy can be carried out to allow for baby

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Sperm capacitation occurs when the sperm cell surface antigens on the acrosome are lost and only occurs when it enters the vagina

Acrosomal enzymes are released from the acrosome of the sperm and onto the zona pellucida of the egg

Fertilization occurs within the ampulla of the fallopian tube

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What kind of ART would be recommended for this couple's case and why is that the more preferred method compared to the various methods?

What test did the doctor performed to identify which of the couple (andrew or elise) had issues with fertility?

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What is the procedure of ARF?
How effective is it?

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Site of human fertilization: Fallopian tube

Fertilization Process
1. Sperm preparation
2. Sperm-Zona Binding
3. Acrosome reaction
4. Sperm Egg fusion
5. Activation of the egg

Polyspermy: Refers to the fertilization of the egg by more than one sperm, resulting in zygotes with greater than a diploid amount of DNA. (More than 2n)

Infertility: Refers to inability to get pregnant over one-year period

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Fertilization occurs in the uterine tube where sperm must be introduced into the female reproductive tract within 5 days before ovulation.

4 Steps of fertilization:

1. preparation of sperm:
- Sperm requires capacitation where the tail of the sperm moves faster

2. sperm-egg binding:
- zona pellucinda binds to sperm
- causes acrosome reaction

3. sperm-egg fusion
- sperm nucleus and other organells are incorporated into the egg cytoplasm

4. activation of egg:
- cortical reaction to prevent polyspermy

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Infertility can be caused by a problem with either the male or female gametes, things such as the sperm are not able to move properly, nonviable sperm, not having functioning enzymes in the acrosomes to dissolve the zona pellucida, The egg having a thicker than normal zona pellucida, cortical granules are prematurely released, which result in the hardening of the zona pellucida, no egg is released, the egg is not able to implant itself properly and many more.
There are 4 main processes of fertilization to occur, first preparation where capacitation and the acrosomal reaction occurs, next is the binding of the gametes, next is the fusion of the sperm and egg's plasma membranes, and lastly is the activation of the zygote.
The sperm has a tail, the middle which has 70 to 100 mitochondria for the sperm to move, the head where an acrosome and the DNA of the male can be found. The egg has the zona pellucida which is made of glycoproteins, there is also a plasma membrane and genetic material also there are about 100 to 200 thousand mitochondria present too.

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Capacitation is a process where the sperm undergoes maturation in order for fertilisation to occur. This process occur in the upper portion female genital tract.

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Infertility can cause symptoms such as irregular periods, severe menstrual cramps, although the cause of most infertilities do not show any symptoms
It could be due to ovulation irregularities, structural problems in the reproductive system (eg. loew sperm count, underlying medical problem)

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Are there any ethical problems surrounding ART

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which are the consideration taken when choosing an ART method?

is there any risk that comes to the baby born through the use of ART methods?

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- couple was not able to conceive for years due to their infertility
- assisted reproductive therapy (ART) has to be performed
process of successful fertilisation:
1. capacitation: preparation of sperm
2. acrosome reaction: sperm and ovum bind together
3. fertilin: sperm and ovum fuse together
4. cortical reaction: ovum becomes activated
types of ART:
- artificial insemination
- in vitro fertilization-embryo transfer (IVF-ET)
- frozen embryo transfer (FET)

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Sperm contains acrosomal enzymes which break down the zona pellucida of the egg to allow the nucleus of the sperm to enter and fertilise the egg.

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What are the steps involved in the various forms of ART?
Does the risk multiple pregnancy increase when undergoing any forms of ART?

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What are the risks involved with using ART

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How effective are ART to increase the chance of pregnancy? Which methods are more suitable?

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Are there any requirements needed to fulfilled before carrying out ART?

Are there any consequences if ART is not carried out properly? If so, what are they?

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IVF - complex series of procedures to help with fertility and assist in conception of a child.
Mature eggs are retrieves from the ovary and fertilised by sperm in the lab. The fertilised egg is transferred into the uterus.
A whole cycle can take three weeks.

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The sperm undergo a process known as capacitation that causes changes to the sperm as they are being discharged into the vagina. For example, as they enter the vagina the Ca+ levels increase, the sperm become motile and the surface antigen of the sperm is lost to be more receptive to the egg. When sperm binds to the egg, the zona pellucida triggers acrosome reactions that allow the sperm to fuse and reach the egg (sperm-egg binding). During the activation stage, sperm cells release their content (e.g haploid nucleus into the egg cytoplasm. Upon fertilization, cortisol reaction occurs to prevent polyspermy.

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Stages in fertilization
1. Sperm preparation
2. Sperm binding
3. Acrosome reaction
4. Sperm-egg fusion
5. Activation of the egg (cortical reaction)

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-fusion of haploid gametes (sperm and egg cell) to form a diploid zygote
-gametes formed by meiosis
-n + n = 2n
-Site of fertilisation: fallopian tube (oviduct)

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which is the most efficient type of ART for andrew & elise?

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- are both andrew and elise infertile?
- what was the cause of the infertility? is it hereditary or acquired?
- which is the safest ART method?
- which is the most guaranteed ART method?

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what are some of the complications of ART in pregnancy?

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- which is the safest and/or most guaranteed ART method?
- what are some negative side effects of ART?

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is there a risk that ART can cause genetic disorders in the offspring

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-does the structure of sperm and egg cells affect its function?
-what causes infertility in women?
-why does the use of ART methods e.g. IVF usually causes more than 1 child /birth --> higher chances of twins, triplets and quadruplets

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What is the recommended type of ART that can be best used in different scenarios?

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What kind of infertility is present between Andrew and Elise ?

What are the possible reasons for infertility ?

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From the Most outer layer to inner layer - Corona Radiata, Zona pellucida, Cytoplasm, Cortical granule, and the Nucleus

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A  egg cell is surrounded by the zone pellucida and corona radiata.

The zona pellucida is like a barrier that protects the egg from sperm

corona radiata provides support and nourished the egg.

Within the cytosplasm of the egg contains centrosome, centriole, mitochondria and cortical granules.

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implantation:
1. endometrium swells, increasing glycogen stores
2. trophoblast secretes enzymes to dissolve wall of endometrium
3. paracrines are secreted which increases the number of capillaries such that are more oxygen and nutrients available in the area and waste products like carbon dioxide are removed.
4. trophoblast then thickens to form chrion which encapsulates the embryo

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Will the risks that comes with ART be taken into consideration when deciding on having a child ?

Which ART will be the most suitable for the married couple ?

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Is IVF practical? How long does the process take? what is the success rate for ART?

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why is there infertility? Is infertility genetic? What are the ways we can use to determine what is the problem causing infertility? Are there other ways fertility could be affected that have nothing to do with the reproductive issues?

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Structure of egg
Corona Radiata - provides the egg with essential proteins. formed by follicle cells adhering to the oocyte before it leaves the ovarian follicle

Zona Pellucida - glycoprotein layer surrounding the plasma membrane of the oocyte. binds spermatozoa to initiate acrosome reaction

Vitelline Membrane - provides conformational change to activate cortical reaction via signal transduction.

Nucleus - control and regulate gene expression

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process of fertilizations:
1) Capacitation ( maturation of spermatozoa, tail of the sperm to move faster)
2) Sperm binding : sperm comes into contact with Zona pellucida and binds to it
3) Acrosomal reaction: acrosome releases hyaluronidase to break down the zona pellucida. the sperm contacts into the plasma membrane and into the cytoplasm
4)sperm-egg binding ( fertilisation)
5)egg activation (secondary oocyte undergoes meiosis 2)
6) cortical reaction: hardening of zona pellucida to prevent polyspermy

fertilisation--> zygote (fertilised ovum)-->cleavage stage (cell split into 2 over and over) ---> Morula( solid ball of cells) --->Blastocyst

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Is the couple's infertility due to genetic defects, or was it developed some time in their life?

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-If there is a method to alter the structure of gametes to make it more efficient in fertilisation?
-What are the advantages and disadvantages of ART methods?

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Is there a specific ART for specific infertility problems?

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Outer layer to inner layer of egg :
-corona radiata: acts as a barrier to protect egg cell & to supply vital proteins to egg cell
-zona pellucida: a super thick layer, which the sperm has to break through in order for sperm to penetrate for the fertilisation to occur
- cytoplasm: contains components for protein synthesis (ribosomes, mRNA, tRNA)
-cortical granule: secretory organelles contain enzymes preventing polyspermy
-nucleus: contains genetic information in the form of chromosomes.
*egg cell has greater number of mitochondria than sperms

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Does IVF allows one to modify the offspring? (gender or twins etc.)

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How does ART overcome the problems of infertility? Is it possible that the infertility is resulted in incorrect timing of the sperm entering the cervix? What ART is best for which situation? Is ART always the solution?