Infertility

SIREESHA SALI
M.SC (N) I YEAR
FEMALE REPRODUCTIVE
SYSTEM
 Definition
• Couples that have been unable to
conceive a child after 12 months of
regular sexual intercourse without birth
control are infertile.

• Not being able to get pregnant despite

having frequent unprotected sex for at
least a year
• Infertility is the inability to conceive a child.
A couple may be considered infertile if,
after two years of regular sexual
intercourse, without contraception, the
woman has not become pregnant (and
there is no other reason, such as
breastfeeding or postpartum
amenorrhoea).
ACC. TO WHO
• Infertility primarily refers to the biological
inability of a person to contribute to
conception. Infertility may also refer to the
state of a woman who is unable to carry a
pregnancy to full term.
• Infertility means not being able to get
pregnant after one year of trying.
INCIDENCE
• Age
Risks
• Stress
• Poor diet
• Smoking
• Alcohol
• STDs
• Overweight
• Underweight
• Caffeine intake
• Too much exercise
 FEMALE INFERTILITY
• Endometriosis
– Interference with tubal patency
– Endometrial fragility
– Adhesions that displace the ovaries
• Tubal Blockage
– Scarring (PID)
– Fibroids
• Uterine Problems
– Tumors, fibroids, poly cystic ovarian disease
– Congenital Anomalies
Poly cystic ovarian syndrome
 Other causes
• Medications
• Thyroid problems
• Cancer and treatment
• Other medical conditions
– conditions associated with delayed puberty or
amenorrhea, sickle cell disease, HIV/AIDS,
kidney disease and diabetes
 teratogens
• Damage from external sources, including
viral infections, x-rays and other radation,
and poor nutrition
• Depending on the stage of development at
which the exposure to the teratogen takes
place, a variation of developmental
malformations may occur.
– Week 8= stunting of the fingers and toes
 Symptoms
• Inability for a couple to get pregnant

• Woman: abnormal menstrual periods

• Man: hormonal problems (changes in hair
growth or sexual function)
 Assessment female history
• Current or past reproductive tract
problems
• Endocrine problems
• Abdominal or pelvic surgeries
• Use of vaginal douches or medications
(interfere with pH)
• Occupational exposure to x-ray or toxic
substances
• Menstrual History
– Age of menarche
– Length, regularity, & frequency of menstrual
periods
– Amount of flow
– Dysmenorhea / PMS
– Contraceptive use
– Hx. Previous pregnancies or abortions
• Endometrial Biopsy
– Paracervical Block to decrease cramping /
pain
– Pinch of endometrium obtained to check for a
luteal phase defect (lack of progesterone
Tests for women
• Ovulation testing
• Hysterosalpingography
• Laparoscopy
• Hormone testing
• Ovarian reserve testing
• Genetic testing
• Pelvic ultrasound
 MEDICAL MANAGEMENT
Drugs
• Clomiphene
• Human menopausal gonadotropin,
hMG
• FSH
Human chorionic
gonadotropin, hCG
Gonadotropin – releasing
hormone (Gn-RH) analogs
Metformin
Bromocriptine
 Assisted reproductive
technology (ART)
 In vitro fertilization (IVF)
 GIFT- GAMATE INTRA FALLOPIAN TRANSFER
 Zygote intrafallopian transfer (ZIFT) or Tubal
Embryo Transfer
 Intracytoplasmic sperm injection (ICSI)
 Intra uterine insemination (IUI)
• In vitro fertilization (IVF)
– Most effective
– Recommended when both fallopian tubes are blocked

it involves ovarian stimulation egg

retrieval, fertilization and embryo
transfer . This procedure is stimulating
the ovary to produce multiple ovums by
medications.
• ART works best when the woman has a
healthy uterus, responds well to fertility
drugs, and ovulates naturally or uses
donor eggs.
• GIFT- GAMATE INTRA FALLOPIAN
TRANSFER
The ovaries are stimulated with
gonadotrophin, oocyte is gathering and
mixed with sperm in a test tube. After that
re insert into the fallopian tubes
 Zygote intrafallopian transfer (ZIFT)
or Tubal Embryo Transfer
• It is similar to IVF. Fertilization occurs in
the laboratory. Then the very young
embryo is transferred to the Fallopian tube
instead of the uterus.
Intracytoplasmic sperm injection
(ICSI)
It is often used for couples in which
there are serious problems with the sperm.
Sometimes it is also used for older
couples or for those with failed IVF
attempts. In ICSI, a single sperm is
injected into a mature egg. Then the
embryo is transferred to the uterus or
Fallopian tube.
 Intrauterine
insemination (IUI)
• Intrauterine insemination (IUI) is an infertility
treatment that is often called artificial insemination.
In this procedure, the woman is injected with
specially prepared sperm. Sometimes the woman is
also treated with medicines that stimulate ovulation
before IUI.
• IUI is often used to treat:
• Mild male factor infertility
• Women who have problems with their cervical
mucus
• Couples with unexplained infertility
 NURSING MANAGEMENT FOR
FEMALE INFERTILITY
• Assess the psychological status of the
patient
• Provide alternative methods of conception
• Administer medications prescribed by
physician
• Provide positive reassurance
• Explain about stress reduction techniques
MALE INFERTILITY
 MALE INFERTILITY CAUSES
• Varicocele – varicose of swollen vein in
the testicle
• Cryptorchidism – undescended testicle at
birth
• Restrictive undergarments
• Occupational exposure to heat
• Working in a seated position
• Immunological Factors
– Autoimmune reaction
– Production of antibodies that destroy sperm
• Obstruction in Sperm Transport
– Mumps
– Epididymitis, STD’s
• Impaired delivery of sperm
• Sexual issues
• Retrograde ejaculation
• Blockage of epididymis or ejaculatory ducts
• No semen (ejaculate)
• Hypospadia
• Anti – sperm antibodies
• Cystic fibrosis
General health and
lifestyle
• Emotional stress
• Malnutrition
• Obesity
• Cancer and its
treatment
• Alcohol and drugs
• Age
• Other medical
conditions
Environmental exposure
• Pesticides and other chemicals
• Overheating the testicles
• Substance abuse
• Tobacco smoking
PATHOPHYSIOLOGY
 Assessment
• General Health
• Nutrition
• Alcohol, drug or tobacco use
• Congenital health problems - hypospadias
or cryptorchidism
• Illnesses such as mumps orchitis, UTI’s, or
STD’s
• Current or past reproductive tract
problems
• Endocrine problems
• Abdominal or pelvic surgeries
• Use of vaginal douches or medications
(interfere with pH)
• Occupational exposure to x-ray or toxic
substances
 Tests and diagnosis
Tests for men
• General physical
examination
• Semen analysis
• Hormone testing
• Transrectal and
scrotal ultrasound
 Semen analysis
• Semen volume
1.5-5ml
• Concentration
> 20 million
• Total sperm
>50-60 million
• Motility
60% grade
 Medical treatments
Fertility drugs and the risk of multiple
pregnancies
• Injectable fertility drugs increase the
chance of multiple births
• Careful monitoring: blood tests, hormone
tests, ultrasound measurement of ovarian
follicle size
• Multifetal pregnancy reduction
 Medical treatments

Surgery
• Laparoscopic techniques
• Blockages, varicocele
 Medical treatments

• Electric or vibratory stimulation to achieve

ejaculation
• Surgical sperm ejaculation
• Intracytoplasmic sperm injection (ICSI)
 Complications of treatment
• Multiple pregnancy
• Ovarian hyperstimulation syndrome
(OHSS)
• Bleeding or infection
• Low birth weight
• Birth defects
 Complementary and alternative
treatments
• Group psychological intervention
• Acupuncture
• Manual physical therapy
• Explain about alternative methods
• Encourage them for surrogacy procedure
• Encourage for child adoptation
 Prevention
Male:
• Avoid alcohol,
tobacco and street
drugs
• Avoid hot tubs and
steam baths
The end