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Maribee T. Espiritu, RN, MD

j

r. Inability to conceive a child or sustain a

pregnancy to childbirth
2. Pregnancy has not occurred after at least
_____ of engaging in unprotected sexual
intercourse
3. no previous conception
4. previous viable pregnancy but couple is
unable to conceive at present
4  




 







v. lessened ability to conceive

7. undescended testes
8. Instillation of sperm into the female
reproductive tract to aid conception.
9. One or more mature oocytes are removed
from a woman¶s ovary by laparoscopy &
fertilized by exposure to sperm under
laboratory conditions outside the woman¶s
body.
r . Oocyte retrieval by transvaginal,
ultrasound-guided aspiration followed by
culture & insemination of the oocytes in the
laboratory
Infertility
s Inability
to conceive a child or
sustain a pregnancy to childbirth
s Pregnancy has not occurred after at least
r year of engaging in unprotected sexual
intercourse
s Affects r4% of couples desiring children
O



Ë Primary infertility ± no previous conception

Ë Secondary infertility ± previous viable
pregnancy but couple is unable to conceive
at present
Ë Sterility ± inability to conceive because of a
known condition, such as the absence of
the uterus.
Ë Subfertility ± lessened ability to conceive
Male Infertility Factors

Ë Disturbance in spermatogenesis (sperm cell

production)
Ë Obstruction in the seminiferous tubules, ducts or
vessels
Ë Qualitative or quantitative changes in the seminal
fluid preventing sperm motility
Ë Development of autoimmunity that immobilizes
sperm
Ë Problems of ejaculation or deposition





Ë Sperm count is the number of sperm in a single

ejaculation or in a milliliter of semen.
Ë Minimum considered normal ± 2 m/ml or
5 m/ejaculation
Ë At least 5 % is motile, 3 %normal in shape & form
Ë Spermatozoa must be produced & maintained at a
temperature slightly lower than body temperature.
Ë This is the reason why the testes is suspended in the
scrotum, away from the body surface.






Ë RYPTOR IDISM ± undescended testes

Ë VARIOELE ± varicosity of the spermatic
vein
Ë Trauma to the testes
Ë Surgery
Ë endocrine imbalance
Ë drug use & excessive alcohol intake
' 

 

Ë May occur at any point

Ë Adhesions & occlusions produced by

± mumps orchitis
± epididymitis
± tubal infections (gonorrhea)
'

 

Ë ongenital stricture of spermatic duct

Ë BP
Ë Autoimmunization after vasectomy
Ë Penile anomalies like YPOSPADIA
(urethral opening on the ventral surface of
the penis) or EPISPADIAS (dorsal surface)
Ë Extreme obesity in male affecting penetration
& deposition
R  


Ë Psychological problems
Ë Debilitating disease such as Parkinson¶s disease or
VA
Ë Medications (anti- PN drugs)
Ë ERETILE DYSFUNTION
¢
  ± never achieve erection & ejaculation

 ± has experienced ejaculation in the past
but now has difficulty
Sildenafil (Viagra) ± drug of choice
Female Infertility Factors
Ë AN'
A|'N
± most common cause of infertility in women
± May result from hormonal imbalance.
Ë Ovarian tumors may produce such d/t
feedback stimulation on the pituitary.
Ë Stress affects by Ļ hypothalamic secretion of
GnR , eventually Ļ L & FS
Ë POS ± ovaries fail to respond to FS
|   


Ë Scarring of the fallopian tube often caused by

PID or salphingitis
Ë PID ± infection of the pelvic organs ; may
lead to pelvic peritonitis
Ë PID usuallt begins with cervical infection that
spreads by surface invasion along the
endometrium and then out to the FT &
ovaries.


 


Ë Tumors
Ë ongenitally deformed uterine cavity
Ë Endometriosis
± Implantation of uterine endometrium, or nodules
that have spread from the interior of the uterus to
locations outside


  


Ë cervical mucus
Ë Polyp obstructing the cervical os

  


Ë Infection that may affect the vaginal p may

limit or destroy the motility of the sperm
Fertility Assessment
ealth history
s General health
s Nutrition
s Alcohol, drug or tobacco use
s ongenital health problems
s urrent illnesses
s Menstrual history
s ontraceptive use
s Pregnancies or abortions
  



s Secondary sex characteristics

s Genital abnormalities
s Breast and thyroid examination
Fertility Assessment

Fertility Testing
Semen Analysis
Ë After 2-4 days of sexual abstinenc
Ë ejaculates by masturbation into a clean, dry specimen
jar
Ë examined within r hour
Ë Number, appearance & motility is noted
Ë Test may be repeated after 2-3 months
Î


A

A


Ë To determine whether a man¶s sperm, once it

reaches the ovum will efectively penetrate.
' 

Ë BBT
Ë Ovulation by test strip
s Assesses upsurge of L that occurs
before ovulation
Tubal Patency
s Sonohysterography
s Ultrasound to inspect uterus
s inspect the uterus for abnormalities
s septal deviation or mass.
s ysterosalpingography
s Radiologic exam of fallopian tubes
s radiopaque medium most commonly used to
assess tubal patency
Advanced Surgical
Procedures


R
   

Ë Used as a test for ovulation or to reveal an

endometrial problem such as luteal phase defect.
Ë Endometrium resembles a corkscrew ± ovulation has
occurred
Ë done 2 or 3 days before the expected menstrual flow
†
 



Ë Suspected pregnancy
Ë Presence of infection

Ë aution that spotting may occur

†
 

Ë Visual inspection of the uterus through the

insertion of a hysteroscope, a thin, hollow
tube, through the cervix.
Ë elpful when uterine adhesions are
discovered previously
  

Ë Introduction of a thin, hollow, lighted tube

through a small incision in the abdomen, just
under the umbilicus
Ë examine the position and state of the FT &
ovaries.
Ë follicular phase of a menstrual period and is
done under GA
Infertility Management
sorrection of underlying problem
sIncreasing sperm count and motility
@@

  
 


sReducing the presence of infection
s ormone therapy ·

 



sSurgery - 2

Assisted Reproductive
Techniques
A 


Ë Instillation of sperm into the female reproductive tract

to aid conception.

Ë RYOPRESERVED (frozen)
Ë r day after ovulation, sperm is injected
A 


 

Ë One or more mature oocytes are removed

from a woman¶s ovary by laparoscopy &
fertilized by exposure to sperm under
laboratory conditions outside the woman¶s
body.
Ë 4 hrs. after fertilization, ova is inserted into
the woman¶s uterus where r would implant &
grow ideally.
Ë Used by couples who has not conceived
Ë Man with oligospermia
Ë Unexplained infertility

Ë Donor ovum maybe used

Ë Before the procedure, GnR is given.
Ë r th day of menstrual cycle, ovaries are
observed. When a mature follicle is seen via
sonography, cg is injected causing
ovulation 38-42 hours later.
 
 


Fertilization of ova & growth in culture medium

Insertion of fertilized ovum into uterus

'

  


Ë Ova obtained as in IVF

Ë Both ova & sperm are instilled within a matter
hours using a laparoscopic technique, into an
open end of a patent FT
Ë ontrainidicated in blocked FT as it may lead
to ectopic pregnancy
ë
  
!ë"|#

Ë Fertilization in the tube, zygote in the uterus

for implantation

Ë Differs from GIFT as there is no need for at

least a functional FT since it is implanted in
the uterus
Î




Ë Assisted in women who does not ovulate

Ë Donated oocyte
Ë Synchronized menstrual cycle of donor &
recipient, gonadotrophic hormones are
administered
|†RRNO

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