Unit 3: Reproductive Challenges and Advances

Lesson 7: Infertility and Assisted Reproductive Technologies (ART)

Learning Outcomes
1. Explain the common causes of infertility in both males and females.
2. Discuss the advancements in Assisted Reproductive Technologies (ART) and their
implications in addressing infertility.
A Phrase
"Hope through science: Overcoming infertility with medical advancements."
Introduction
Infertility is a medical condition affecting millions of couples worldwide. According to the
Centers for Disease Control and Prevention (CDC, 2023), infertility is defined as the inability to
conceive after one year of unprotected intercourse. Infertility can be caused by various factors,
including biological, genetic, environmental, and lifestyle-related conditions. With the rapid
progress of medical science, Assisted Reproductive Technologies (ART) have provided new
avenues for individuals and couples facing infertility, giving them hope for conception and
parenthood.
Preparatory Activities
Let’s Look Back
• Reflect on reproductive health and its importance in human development.
• Identify different factors that can impact fertility.
Let’s Analyze and Prepare
• Discuss societal attitudes toward infertility.
• Share knowledge on available treatments for infertility.

Lesson Presentation
Common Causes of Infertility
Infertility is a complex condition that can be caused by various factors in both males and females.
1. Female Infertility Causes
Women may experience infertility due to conditions affecting ovulation, egg quality, or
reproductive structures (American College of Obstetricians and Gynecologists [ACOG], 2022):
• Ovulatory disorders: Polycystic ovary syndrome (PCOS), hypothalamic dysfunction, and
premature ovarian failure can cause irregular or absent ovulation.
• Endometriosis: A condition where tissue similar to the lining of the uterus grows outside
the uterus, causing inflammation and scarring that affects fertility.
• Blocked fallopian tubes: Infections, pelvic inflammatory disease (PID), or prior surgeries
may lead to blockages, preventing egg and sperm interaction.
• Age-related decline: Egg quality and quantity naturally decline with age, reducing fertility
potential.
• Hormonal imbalances: Thyroid disorders, hyperprolactinemia, or adrenal gland
dysfunction can interfere with ovulation and implantation.
2. Male Infertility Causes
Male infertility can result from problems related to sperm production, function, or delivery (World
Health Organization [WHO], 2023):
• Low sperm count and poor motility: Conditions such as varicocele (enlarged veins in
the testicles) can impair sperm production.
• Hormonal disorders: Testosterone deficiencies, pituitary gland dysfunction, or thyroid
disorders can affect sperm development.
• Genetic conditions: Klinefelter syndrome and other chromosomal abnormalities can
impact fertility.
• Testicular injury or infections: Mumps, sexually transmitted infections (STIs), or trauma
can damage sperm-producing tissues.
 • Lifestyle factors: Smoking, excessive alcohol consumption, obesity, and drug use can
reduce sperm quality and motility.
Advances in Assisted Reproductive Technologies (ART)
Assisted Reproductive Technologies (ART) have revolutionized fertility treatments by
offering advanced solutions to individuals and couples facing infertility. ART refers to medical
procedures that involve the manipulation of eggs, sperm, or embryos to facilitate conception.
These technologies continue to evolve, improving success rates and accessibility. Below are the
most common ART procedures:

1. In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF) is the most widely used ART procedure. It involves stimulating the
ovaries with hormones to produce multiple eggs, retrieving these eggs from the ovaries, fertilizing
them with sperm in a controlled laboratory setting, and then implanting the resulting embryos into
the woman’s uterus (American Society for Reproductive Medicine [ASRM], 2022). IVF is often
recommended for couples experiencing:
• Blocked or damaged fallopian tubes
• Unexplained infertility
• Endometriosis-related infertility
• Male factor infertility (low sperm count, poor motility)
• Advanced maternal age
IVF has advanced significantly with the introduction of blastocyst culture, where embryos are
allowed to develop for five to six days before transfer, increasing implantation success (Centers
for Disease Control and Prevention [CDC], 2023).

2. Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection (ICSI) is a specialized form of IVF used primarily for cases of
severe male infertility. In this procedure, a single healthy sperm is directly injected into an egg
using a microscopic needle to facilitate fertilization (European Society of Human Reproduction
and Embryology [ESHRE], 2021). ICSI is beneficial for:
• Men with very low sperm count
• Sperm with poor motility or abnormal shape
• Cases of prior failed IVF due to fertilization issues
• Use of frozen sperm samples (e.g., from cancer patients before chemotherapy)
3. Surrogacy
Surrogacy is an ART option for individuals who cannot carry a pregnancy. It involves another
woman (the surrogate) carrying and giving birth to a baby on behalf of intended parents. There
are two types of surrogacy:
• Traditional Surrogacy: The surrogate’s egg is used, making her the biological mother.
• Gestational Surrogacy: The intended mother’s (or donor’s) egg is fertilized via IVF and
implanted into the surrogate’s uterus, ensuring no genetic link between the surrogate and
the child (ASRM, 2022).
Surrogacy is often used by women with uterine abnormalities, those who have had multiple
miscarriages, or same-sex male couples.
4. Egg and Sperm Donation
Egg and sperm donation allow individuals who cannot produce viable gametes to conceive.
• Egg Donation: A donor provides eggs that are fertilized with the intended father’s sperm
(or donor sperm) and implanted into the intended mother or surrogate.
• Sperm Donation: A sperm donor provides sperm that is used for intrauterine insemination
(IUI) or IVF.
This method is widely used in cases of premature ovarian failure, genetic disorders, and for
LGBTQ+ couples seeking to conceive (National Institutes of Health [NIH], 2021).
5. Preimplantation Genetic Testing (PGT)
Preimplantation Genetic Testing (PGT) is a technique used to screen embryos for genetic
disorders before implantation. It is particularly useful for couples with a high risk of passing on
inherited conditions (CDC, 2023). There are three types of PGT:
• PGT-A (Aneuploidy Screening): Identifies embryos with abnormal chromosome
numbers, reducing the risk of miscarriage and genetic syndromes like Down syndrome.
• PGT-M (Monogenic Disorder Testing): Screens for specific inherited conditions, such
as cystic fibrosis or sickle cell anemia.
• PGT-SR (Structural Rearrangement Testing): Detects chromosomal rearrangements
that can lead to failed implantation or miscarriage.
PGT enhances the success rates of IVF by selecting only healthy embryos for transfer.
6. Cryopreservation (Egg, Sperm, and Embryo Freezing)
Cryopreservation is the process of freezing and storing eggs, sperm, or embryos for future use.
This technique is beneficial for:
• Women who wish to delay childbearing (social or medical reasons)
• Cancer patients preserving fertility before undergoing chemotherapy or radiation
• Individuals undergoing multiple IVF cycles, allowing unused embryos to be stored for
future attempts (ESHRE, 2021).
7. Mitochondrial Replacement Therapy (MRT)
MRT is a cutting-edge ART procedure that prevents the transmission of mitochondrial diseases.
It involves replacing defective mitochondria in an egg with healthy mitochondria from a donor,
ensuring the child inherits healthy mitochondrial DNA (National Institute for Health and Care
Excellence [NICE], 2022).

Ethical Considerations and Future Directions

Despite its benefits, ART raises ethical and social concerns, including:
• Cost and accessibility: ART procedures are expensive and not always covered by
insurance.
• Multiple pregnancies: IVF increases the likelihood of twins or triplets, which can pose
risks to maternal and fetal health.
• Embryo selection and genetic modification: The use of PGT raises ethical debates
over embryo selection and the potential for "designer babies."
• Legal and social implications of surrogacy: Surrogacy laws vary globally, and conflicts
can arise regarding parental rights.

The future of ART continues to evolve with innovations such as artificial gametes,
improved embryo culture techniques, and robotic-assisted embryo transfer, promising
higher success rates and expanded reproductive options.

Enrichment and Enhancement Activities

Let’s Do It
• Research and present a case study on a couple who successfully conceived using ART.
• Debate on the ethical considerations of surrogacy and genetic embryo screening.
Try Some More
• Interview a fertility specialist or read medical journal articles on the latest ART
advancements.
Evaluation
Let’s Have Your Turn
1. Which of the following is NOT a common cause of female infertility? a. Endometriosis
b. Low sperm motility
 c. Blocked fallopian tubes
d. Hormonal imbalances
2. What is the primary purpose of Preimplantation Genetic Testing (PGT)? a. To increase
egg production
b. To identify genetic disorders before embryo implantation
c. To improve sperm quality
d. To prevent multiple pregnancies
Let’s Sum It Up
• Infertility affects both men and women due to various medical and lifestyle factors.
• ART provides multiple options for individuals and couples struggling with infertility.
• Ethical and medical considerations must be addressed in ART procedures.
Let’s Extend and Link
• Read WHO’s latest guidelines on ART advancements.
• Explore the role of genetics in reproductive health and disease prevention.
References
• American College of Obstetricians and Gynecologists. (2022). Female infertility: Causes
and treatment. Retrieved from https://www.acog.org/
• American Society for Reproductive Medicine. (2022). Assisted reproductive technologies:
A guide for patients. Retrieved from www.asrm.org
• American Society for Reproductive Medicine. (2022). Assisted reproductive technology
guidelines. Retrieved from https://www.asrm.org/
• Centers for Disease Control and Prevention. (2023). Infertility and reproductive health.
Retrieved from https://www.cdc.gov/
• Centers for Disease Control and Prevention. (2023). Assisted reproductive technology
success rates. Retrieved from www.cdc.gov
• European Society of Human Reproduction and Embryology. (2021). ART and infertility
treatments: Guidelines and updates. Retrieved from www.eshre.eu
• National Institutes of Health. (2021). Advancements in reproductive medicine and fertility
treatments. Retrieved from www.nih.gov
• National Institute for Health and Care Excellence. (2022). Mitochondrial replacement
therapy guidelines. Retrieved from www.nice.org.uk
• World Health Organization. (2023). Male infertility: Causes and treatment options.
Retrieved from https://www.who.int/
Lesson 8: Genetic Counseling and Prenatal Diagnosis
Learning Outcomes
1. Explain the significance of genetic counseling and prenatal diagnosis in reproductive
health.
2. Evaluate the ethical considerations involved in genetic screening and prenatal testing.
A Phrase
"Empowering informed decisions through genetic knowledge."
Introduction
Advancements in genetic science have greatly improved our ability to diagnose and prevent
hereditary disorders. Genetic counseling and prenatal diagnosis play a crucial role in identifying
potential genetic risks, allowing parents to make informed reproductive decisions. These services
provide individuals and families with valuable insights into genetic conditions, their inheritance
patterns, and available treatment or management options (National Society of Genetic
Counselors [NSGC], 2023).
Preparatory Activities
Let’s Look Back
• Recall any genetic conditions or hereditary diseases in your family or community.
• Discuss the importance of early disease detection and its impact on health outcomes.
Let’s Analyze and Prepare
• Debate the role of genetics in determining an individual's health.
• Examine real-life cases where genetic counseling has influenced reproductive choices.
Lesson Presentation
What is Genetic Counseling?
Genetic counseling is a process that helps individuals and families understand and adapt to the
medical, psychological, and familial implications of genetic conditions. It involves assessing the
risk of inherited diseases, discussing testing options, and providing guidance on reproductive
choices (American College of Medical Genetics and Genomics [ACMG], 2023). Genetic
counseling is typically conducted by trained genetic counselors or medical professionals
specializing in genetics.
The Importance of Genetic Counseling
Genetic counseling is essential for individuals and couples with:
• A family history of genetic disorders (e.g., sickle cell anemia, cystic fibrosis, Tay-Sachs
disease)
• Previous pregnancies affected by genetic abnormalities
• Advanced maternal age (35 years or older), which increases the risk of chromosomal
abnormalities
• Exposure to environmental or occupational hazards that may impact fetal development
• A history of recurrent miscarriages or infertility (American Society of Human Genetics
[ASHG], 2022)
Prenatal Diagnosis
Prenatal diagnosis involves medical tests that detect genetic or chromosomal abnormalities in a
developing fetus. These tests help identify conditions that may affect the baby’s health and
development before birth. They are broadly classified into screening tests and diagnostic tests
(World Health Organization [WHO], 2023).
1. Prenatal Screening Tests
Screening tests assess the likelihood that a fetus has a genetic disorder. These tests do not
provide a definitive diagnosis but help determine whether further testing is needed. Common
screening tests include:
 • Maternal Serum Screening: Measures specific proteins and hormones in the mother's
blood to assess the risk of Down syndrome, trisomy 18, and neural tube defects.
• Non-Invasive Prenatal Testing (NIPT): Analyzes fetal DNA in the mother’s bloodstream
to detect chromosomal abnormalities with high accuracy.
• Ultrasound Screening: Assesses fetal anatomy and detects structural anomalies such
as congenital heart defects or neural tube defects (Centers for Disease Control and
Prevention [CDC], 2023).
2. Prenatal Diagnostic Tests
Diagnostic tests confirm whether a fetus has a genetic or chromosomal condition. These tests are
more invasive and carry a small risk of miscarriage. Common diagnostic tests include:
• Amniocentesis: A small sample of amniotic fluid is collected from the uterus to analyze
fetal chromosomes, genes, and proteins. It is commonly used to diagnose Down
syndrome and other chromosomal abnormalities.
• Chorionic Villus Sampling (CVS): A small sample of placental tissue is taken to analyze
fetal DNA. It is performed earlier in pregnancy than amniocentesis and can detect genetic
disorders such as Tay-Sachs disease and sickle cell anemia.
• Fetal MRI and Ultrasound: Provides detailed images of fetal development and helps
detect structural anomalies (March of Dimes, 2023).

Summary of Diseases Covered by Genetic Counseling

Genetic counseling helps individuals and families understand inherited diseases and make
informed health decisions. It covers various genetic conditions, including:
1. Single-Gene Disorders (caused by a mutation in one gene)
o Cystic fibrosis – Affects the lungs and digestion.
o Sickle cell disease – Causes abnormal red blood cells.
o Huntington’s disease – A brain disorder that worsens over time.
o Marfan syndrome – Affects body tissues, leading to heart and bone problems.
2. Chromosomal Disorders (caused by extra/missing chromosomes)
o Down syndrome – Causes intellectual disabilities and distinct physical features.
o Turner syndrome – Affects female growth and development.
o Klinefelter syndrome – Affects male reproductive health.
3. Multifactorial Disorders (caused by both genes and the environment)
o Heart defects – Some are inherited, while others result from pregnancy factors.
o Diabetes (Type 1) – An autoimmune disease with genetic risks.
o Certain cancers (e.g., breast cancer, colon cancer) – Can run in families due
to inherited gene mutations.
4. Genetic Conditions in Pregnancy (screened before or during pregnancy)
o Thalassemia – A blood disorder common in certain ethnic groups.
o Fragile X syndrome – A leading cause of intellectual disabilities.
o Duchenne muscular dystrophy – Causes muscle weakness from childhood.
5. Cancer Risk Syndromes (inherited cancer risks)
o Breast and ovarian cancer (BRCA1, BRCA2 mutations).
o Lynch syndrome – Increases the risk of colon and other cancers.
6. Neurological and Muscle Disorders
o Alzheimer’s disease (early-onset) – Can be inherited in some cases.
o Amyotrophic lateral sclerosis (ALS) – Affects nerve cells and muscle control.
Ethical Dilemmas in Prenatal Testing
While prenatal testing provides valuable information, it also raises ethical concerns:
• Reproductive Decision-Making: Parents must decide whether to continue a pregnancy
after receiving a diagnosis of a genetic condition. This can be emotionally challenging and
influenced by personal, cultural, and religious beliefs.
 • Privacy and Genetic Discrimination: There are concerns about how genetic information
is used and whether it may lead to discrimination in employment or insurance.
• Selective Termination: Some critics argue that prenatal testing may lead to increased
termination of pregnancies involving genetic abnormalities, raising ethical and moral
questions (National Institutes of Health [NIH], 2023).
• Emotional and Psychological Impact: Learning about a genetic condition before birth
can cause stress and anxiety for expectant parents.
Enrichment and Enhancement Activities
Let’s Do It
• Research a genetic disorder and present how genetic counseling and prenatal diagnosis
help families manage it.
• Interview a healthcare professional about the challenges and benefits of prenatal testing.
Try Some More
• Debate the ethical implications of genetic testing and its potential for discrimination.
• Analyze a case study where prenatal testing impacted a family’s reproductive decision-
making.
Evaluation
Let’s Have Your Turn
1. Which of the following is NOT a purpose of genetic counseling? a. Assessing the risk of
inherited diseases
b. Predicting a person’s intelligence level
c. Discussing genetic testing options
d. Providing emotional support for genetic conditions
2. What is the difference between prenatal screening and diagnostic tests? a. Screening
tests confirm a genetic disorder, while diagnostic tests assess risk.
b. Screening tests assess the risk of a disorder, while diagnostic tests confirm the
diagnosis.
c. Diagnostic tests are always non-invasive, while screening tests are invasive.
d. Both screening and diagnostic tests provide definitive results.
Let’s Sum It Up
• Genetic counseling provides crucial information about inherited diseases and reproductive
choices.
• Prenatal diagnosis helps detect genetic abnormalities early in pregnancy, guiding medical
and ethical decisions.
• Ethical dilemmas in genetic testing must be considered carefully to balance medical
advancements and moral considerations.
Let’s Extend and Link
• Explore the latest WHO guidelines on genetic counseling and prenatal screening.
• Learn about new advancements in genetic therapy and fetal medicine.
References
• American College of Medical Genetics and Genomics. (2023). Genetic counseling and its
role in reproductive health. Retrieved from https://www.acmg.net/
• American Society of Human Genetics. (2022). Prenatal genetic testing and screening:
Ethical considerations. Retrieved from https://www.ashg.org/
• Centers for Disease Control and Prevention. (2023). Prenatal testing and pregnancy
health. Retrieved from https://www.cdc.gov/
• March of Dimes. (2023). Prenatal testing for birth defects. Retrieved from
https://www.marchofdimes.org/
• National Institutes of Health. (2023). Ethical issues in prenatal genetic testing. Retrieved
from https://www.nih.gov/
 • World Health Organization. (2023). Genetic counseling and reproductive health services.
Retrieved from https://www.who.int/

Lesson 9: Birth and Postnatal Care

Learning Outcomes
By the end of this lesson, students should be able to:
1. Describe the stages of labor and childbirth, including physiological and psychological
changes.
2. Explain the essential components of neonatal care and maternal recovery after childbirth.

A Phrase
“Birth is not only about making babies. It’s about making mothers—strong, competent, capable
mothers who trust themselves and believe in their inner strength.” – Barbara Katz Rothman

Introduction
Childbirth is a crucial event in a woman’s life, encompassing various physical and emotional
changes. Understanding the stages of labor, neonatal care, and maternal recovery is essential in
ensuring the well-being of both the mother and the newborn. Proper postnatal care plays a
significant role in preventing complications and promoting maternal and infant health. This lesson
will provide a detailed discussion of labor, childbirth, and essential postnatal care practices based
on evidence-based guidelines.

Preparatory Activities
Let’s Look Back
1. What are the key roles of the placenta during pregnancy?
2. How does the mother’s body prepare for labor in the final weeks of pregnancy?
Let’s Analyze and Prepare
1. Think about common concerns expectant mothers have before childbirth. What factors
may influence a smooth delivery?
2. Why do newborns require immediate medical attention after birth?

Lesson Presentation
Stages of Labor and Childbirth
Labor and childbirth are divided into three main stages:
Stage 1: Early Labor, Active Labor, and Transition
• Early Labor (Latent Phase): Contractions begin, cervix starts dilating (0-6 cm).
• Active Labor: Stronger contractions, cervix dilates from 6-10 cm. This is when most
women are admitted to the hospital.
• Transition Phase: The most intense phase before pushing, characterized by rapid
dilation and strong contractions.
Stage 2: Delivery of the Baby
• Begins when the cervix is fully dilated (10 cm) and ends with the birth of the baby.
• The mother pushes with each contraction to help deliver the baby.
• The healthcare provider may perform an episiotomy in some cases (controlled surgical
incision to prevent tearing).
Stage 3: Delivery of the Placenta
• After the baby is born, the uterus continues contracting to expel the placenta.
• This stage usually lasts between 5-30 minutes.
• Healthcare providers check for excessive bleeding and ensure the uterus begins to
contract properly to prevent postpartum hemorrhage.
(World Health Organization [WHO], 2022; American College of Obstetricians and Gynecologists
[ACOG], 2023)
Neonatal Care
Newborn care is essential for survival, growth, and development. Key components include:
1. Immediate Postnatal Care
o Apgar Score Assessment (Appearance, Pulse, Grimace, Activity, Respiration) at
1 and 5 minutes after birth.
o Skin-to-skin Contact: Helps regulate body temperature and promotes
breastfeeding.
o Umbilical Cord Care: Clamped and cut under sterile conditions to prevent
infection.
2. Newborn Screening and Immunization
o Metabolic and Genetic Screening: Identifies disorders like phenylketonuria
(PKU) and congenital hypothyroidism.
o Vitamin K Injection: Prevents bleeding disorders.
o Hepatitis B Vaccination: Given within the first 24 hours.
3. Breastfeeding and Nutrition
o Exclusive breastfeeding is recommended for the first six months.
o Colostrum, the first milk, provides antibodies that strengthen the baby’s immune
system.
(Centers for Disease Control and Prevention [CDC], 2023; WHO, 2022)
Maternal Recovery and Postnatal Care
1. Physical Recovery
o Uterus contractions continue for several weeks to return to pre-pregnancy size
(involution).
o Lochia (postpartum bleeding) occurs and gradually decreases.
o Vaginal or C-section healing requires proper hygiene and rest.
2. Emotional and Psychological Recovery
o Postpartum blues (mood swings, anxiety) are common and usually resolve in two
weeks.
o Postpartum depression affects about 10-15% of women and requires medical
attention.
o Family and peer support is essential for the mother’s mental well-being.
3. Postnatal Check-ups
o First visit usually occurs within 1-2 weeks after birth.
o Blood pressure, healing of stitches, and breastfeeding progress are monitored.
o Contraceptive counseling may be provided.
(American Academy of Pediatrics [AAP], 2023; WHO, 2022)

Enrichment and Enhancement Activities

Let’s Do It!
1. Create a visual timeline of the stages of labor and childbirth.
2. Role-play a scenario where you provide guidance to a new mother about newborn care.
Try Some More
1. Research common cultural practices related to postnatal care in different countries.
Compare and contrast them with WHO guidelines.
2. Interview a healthcare professional (nurse, midwife, or obstetrician) about challenges in
postnatal care.
Evaluation
Let’s Have Your Turn
 1. Multiple-choice: What is the recommended time for the first postnatal visit? a. 24 hours
after birth
b. 1-2 weeks after birth
c. 6 weeks after birth
d. 3 months after birth
(Answer: b)
2. Situational: A mother reports that her newborn is not feeding well and appears yellowish.
What should she do, and why? (Expected answer: Seek medical attention immediately;
jaundice may indicate neonatal hyperbilirubinemia, requiring treatment.)
Let’s Sum It Up
• The three stages of labor are early labor, active labor, and delivery of the baby and
placenta.
• Neonatal care includes Apgar scoring, breastfeeding support, and immunization.
• Maternal recovery involves physical healing, psychological adjustment, and postpartum
visits.
Let’s Extend and Link
• Research the impact of postpartum depression on child development.
• Explore how public health policies influence maternal and neonatal care worldwide.

References
• American Academy of Pediatrics. (2023). Guidelines for newborn care.
https://www.aap.org
• American College of Obstetricians and Gynecologists. (2023). Postpartum care
recommendations. https://www.acog.org
• Centers for Disease Control and Prevention. (2023). Postnatal and neonatal care
guidelines. https://www.cdc.gov
• World Health Organization. (2022). Maternal and newborn health recommendations.
https://www.who.int