1. INFERTILITY

3. DEFINITION
 Infertility is defined as a failure to
conceive within one or more years of
regular unprotected intercourse.
 Infertility means not being able to get
pregnant after one year of trying. Or,
six months, if a woman is 35 or older.
Women who can get pregnant but are
unable to stay pregnant may also be
infertile

4. Pregnancy is the result of a
process that has many steps. To
get pregnant:
 A woman must release an egg from
one of her ovaries (ovulation).
 The egg must go through a Fallopian
tube toward the uterus (womb).
 A man's sperm must join with
(fertilize) the egg along the way.
 The fertilized egg must attach to the
inside of the uterus (implantation).

5. Types:
 Primary infertility: refers to couples
who have not become pregnant after
at least 1 year of unprotected sex
(intercourse).
 Secondary infertility: refers to
couples who have been pregnant at
least once, but never again.

6. CAUSES OF INFERTILITY:
 Common causes of infertility of
females include:
 ovulation problems
 tubal blockage
 age-related factors
 uterine problems
 previous tubal ligation
 endometriosis

8. CAUSES OF INFERTILITY:

9.  Cancer or tumor
 Clotting disorders
 Diabetes
 Growths (such as fibroids or polyps) in
the uterus and cervix
 Birth defects that affect the
reproductive tract
 Excessive exercising
 Eating disorders or poor nutrition
 Use of certain medications, including
chemotherapy drugs

10.  Drinking too much alcohol
 Obesity
 Older age
 Ovarian cysts and polycystic ovary
syndrome (PCOS)
 Pelvic infection or pelvic inflammatory
disease (PID)
 Scarring from sexually transmitted
infection or endometriosis
 Thyroid disease
 Too little or too much hormone.

11.  Male infertility may be due to:
 A decrease in sperm count
 Sperm being blocked from being
released
 Sperm that do not work properly
 heavy alcohol use
 drugs
 environmental toxins, including
pesticides and lead
 smoking cigarettes

12.  health problems such as mumps,
serious conditions like kidney disease,
or hormone problems
 Use of certain drugs, such as
cimetidine, spironolactone, and
nitrofurantoin
 Radiation treatment and chemotherapy
for cancer
 Being in high heat for prolonged
periods
 Birth defects
 Too little or too much hormones

13.  Impotence
 Infection
 Older age
 Scarring from sexually transmitted
diseases, injury, or surgery
 Retrograde ejaculation

14. INVESTIGATION OF
INFERTILITY:
 General medical history
 Surgical history
 Menstrual history
 Previous obstetrical history
 Contraceptive history
 Sexual problems

15.  Diagnostic TestsBlood and imaging
tests will be done. In WOMEN, this
may include:
 Blood tests to check hormone levels,
including progesterone and follicle
stimulating hormone
 Checking body temperature first thing
in the morning to check if the ovaries
are releasing eggs

16.  Hystero-salpingography (HSG)
 Pelvic ultrasound
 Laparoscopy
 Luteinizing hormone urine test
(ovulation prediction)
 Thyroid function tests

17.  Some common tests of fertility in
women include:
 Hystero-salpingography: This is an
X-ray of the uterus and Fallopian
tubes. Doctors inject a special dye into
the uterus through the vagina. This
dye shows up in the X-ray. Doctors
can then watch to see if the dye moves
freely through the uterus and Fallopian
tubes.
 .

18.  This can help them find physical
blocks that may be causing infertility.
Blocks in the system can keep the egg
from moving from the Fallopian tube to
the uterus. A block could also keep the
sperm from reaching the egg.

19.  Laparoscopy: A minor surgery to see
inside the abdomen. The doctor does
this with a small tool with a light called
a laparoscope .She or he makes a
small cut in the lower abdomen and
inserts the laparoscope. With the
laparoscope, the doctor can check the
ovaries, Fallopian tubes, and uterus
for disease and physical problems.
Doctors can usually find scarring and
endometriosis by laparoscopy.

20.  During this surgery doctors use a tool
called a laparoscope to see inside the
abdomen. The doctor makes a small
cut in the lower abdomen and inserts
the laparoscope. Using the
laparoscope, doctors check the
ovaries, Fallopian tubes, and uterus
for disease and physical problems.
Doctors can usually find scarring and
endometriosis by laparoscopy

22. 1.HISTORY
2.GENERAL
EXAMINATION
3.LOCAL EXAMINATION
4.SPECIAL
INVESTIGATION

23. # SEMEN ANALYSIS
A normal semen analysis
show: ~semen volume:1.5 to
5 ml
~concentration:>20 million
sperm/ml
~total sperm count:>50 to 60
million
Any abnormality in this
result will show chances of
infertility.

24. # POSTCOITAL TEST
# SPERM PENETRATION TEST
# TESTICULAR BIOPSY
# IMMUNOLOGICAL TESTS
# CHROMOSOMAL STUDIES

25.  Male factor infertility account for
about half of all infertility problems.
Problems for the male can include:
 Lack of Sperm -AZOOSPERMIA
 Abnormal Sperm-
TERATOSPERMIA
 Absence of semen-ASPERMIA
 Impaired motility of sperm-
ASTHENOSPRMIA
 Dead sperms-NECROSPERMIA

26. TREAT INFERTILITY IN
MEN
 Sexual problems: help men deal with
impotence or premature ejaculation.
Behavioral therapy and/or medicines
can be used in these cases.
 Too few sperm: Sometimes surgery
can correct the cause of the problem.
In other cases, surgically remove
sperm directly from the male
reproductive tract..

27.  Antibiotics can also be used to clear
up infections affecting sperm count.
 Sperm movement: Sometimes semen
has no sperm because of a block in
the man's system. In some cases,
surgery can correct the problem.

28. Tests in MEN may include:
In men, -by testing the
semen. Normal semen values as suggested
by WHO :
 Volume - 2.0 ml or more
 pH - 7.2 -7.8
 Sperm concentration – 20 million / ml
or more
 Total sperm count - 40 million per
ejaculate

29.  Motility – 50 percent or more
progressive forward motility
 Morphology – 15 percent or more
normal form
 Viability – 75% or more living
 Leucocytes – Less than 1 million/ ml

30. TREATMENT OF
INFERTILITY IN
WOMEN
 Clomiphene citrate (Clomid): This
medicine causes ovulation by acting
on the pituitary gland. It is often used
in women who have polycystic ovarian
syndrome (PCOS) or other problems
with ovulation. This medicine is taken
by mouth.

31.  Human menopausal gonadotropin
or hMG (Repronex, Pergonal): This
medicine is often used for women who
don't ovulate due to problems with
their pituitary gland. hMG acts directly
on the ovaries to stimulate ovulation.
It is an injected medicine.

32.  Follicle-stimulating hormone or FSH
(Gonal-F, Follistim): FSH works
much like hMG. It causes the ovaries
to begin the process of ovulation.
These medicines are usually injected.

33.  Gonadotropin-releasing hormone
(Gn-RH) analog: These medicines
are often used for women who don't
ovulate regularly each month. Women
who ovulate before the egg is ready
can also use these medicines. Gn-RH
analogs act on the pituitary gland to
change when the body ovulates.
These medicines are usually injected
or given with a nasal spray.

34. Testosterone:It improves
testicular function.
Testosterone patch is
applied directly to the
scrotum (TESTODERM)
OR ANDRODERM.
Sildenafil (Viagra): It
improves ERECTILE
DYSFUNCTION

35.  Bromocriptine (Parlodel): This
medicine is used for women with
ovulation problems due to high levels
of prolactin. Prolactin is a hormone
that causes milk production .

36. ASSISTED REPRODUCTIVE
TECHNOLOGY (ART):
 Success rates vary and depend on
many factors. Some things that affect
the success rate of ART include:
 age of the partners
 reason for infertility
 clinic
 type of ART
 if the egg is fresh or frozen
 if the embryo is fresh or frozen

37.  Common methods of ART include:
 Intrauterine insemination (IUI):
 In vitro fertilization (IVF) .
 Zygote intra fallopian transfer (ZIFT)
or Tubal Embryo Transfer is similar to
IVF.
 Gamete intra fallopian transfer (GIFT)
 Intra cytoplasmic sperm injection
(ICSI)
 Surrogacy
 Gestational Carrier

38.  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

40.  In vitro fertilization (IVF) means
fertilization outside of the body. IVF is
the most effective ART. It is often used
when a woman's Fallopian tubes are
blocked or when a man produces too
few sperm. Doctors treat the woman
with a drug that causes the ovaries to
produce multiple eggs. Once mature,
the eggs are removed from the woman.
They are put in a dish in the lab along
with the man's sperm for fertilization.
After 3 to 5 days, healthy embryos are
implanted in the woman's uterus.

42.  Zygote intra fallopian transfer (ZIFT)
or Tubal Embryo Transfer is similar
to IVF. Fertilization occurs in the
laboratory. Then the very young
embryo is transferred to the Fallopian
tube instead of the uterus.

44.  Gamete intra fallopian transfer
(GIFT) involves transferring eggs and
sperm into the woman's Fallopian
tube. So fertilization occurs in the
woman's body. Few practices offer
GIFT as an option.

47.  Intra cytoplasmic sperm injection
(ICSI) 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.

48.  ART procedures sometimes involve
the use of donor eggs (eggs from
another woman), donor sperm, or
previously frozen embryos. Donor
eggs are sometimes used for women
who cannot produce eggs. Also, donor
eggs or donor sperm is sometimes
used when the woman or man has a
genetic disease that can be passed on
to the baby.

49.  An infertile woman or couple may also
use donor embryos. These are
embryos that were either created by
couples in infertility treatment or were
created from donor sperm and donor
eggs. The donated embryo is
transferred to the uterus. The child will
not be genetically related to either
parent.

50. SPERM DONATION
There are selected
groups of patients to
whom sperm donation is
recommended.

51.  #TUBAL REVERSAL
 A common dilemma many individuals
face if they've previously had a tubal
ligation is whether they should undergo
a microscopic tubal ligation reversal vs.
an In Vitro Fertilization (IVF) procedure.
While a tubal reversal does require
more skill than an IVF procedure, a
tubal reversal is actually the better
option for most patients. THE success
rate with microsurgical tubal reversal
is about 95% if and only if the
surgeon has good skill.
 IT needs one small incision n 1 day
hospitalization.

52.  #MICROSCOPIC VASECTOMY
REVERSAL
 Vasectomy Reversal is a procedure
which allows men who have
previously undergone vasectomy to
become fertile again. The vas
deferens is microsurgically
reconnected and the epididymal
blowouts are microsurgically
bypassed, allowing sperm to travel
out of the epididymis and into the
EJACULATION

53. MICRO ASSISTED
FERTILIZATION(MAF)
IT occurs in vitro and is expensive
used in
* IVF or GIFT fails
* Immunological derived infertility
* Inability of sperm to penetrate
egg

54. IN VITRO
FERTILIZATION (IVF)
 Definition:In vitro fertilization (IVF) is a
procedure in which eggs (ova) from a
woman's ovary are removed. They
are fertilized with sperm in a
laboratory procedure, and then the
fertilized egg (embryo) is returned to
the woman's uterus.

55.  In vitro fertilization
(IVF) is the joining
of a woman’s egg
and a man’s
sperm in a
laboratory dish. In
vitro means
“outside the
body.”
Fertilization
means the sperm
has attached to
and entered the
egg.

56. Purposes:
 IVF is one of several assisted
reproductive techniques (ART) used
to help infertile couples to conceive a
child. If after one year of having
sexual intercourse without the use of
birth control a woman is unable to get
pregnant, infertility is suspected.

57. Preparation
 The woman may be given a sedative
prior to the procedure. A local
anesthetic agent may also be used
to reduce discomfort during the
procedure.

58. Method:
 Step 1: Stimulation, also called
super ovulation
 Step 2: Egg retrieval
 Step 3: Insemination and
Fertilization
 Step 4: Embryo culture
 Step 5: Embryo transfer

59. Step 1: Stimulation, also called
super ovulation

60. Step 2: Egg retrieval

61. Why the Procedure Is
Performed
 Advanced age of the woman
(advanced maternal age)
 Damaged or blocked fallopian tubes
(can be caused by pelvic inflammatory
disease or prior reproductive surgery)
 Endometriosis
 Male factor infertility, including
decreased sperm count and blockage
 Unexplained infertility

62. Risks
 IVF requires a significant physical,
emotional, financial, and time
commitment. Stress and depression
are common among couples dealing
with infertility.
 fertility drugs may cause ovarian
hyperstimulation syndrome (OHSS),
decreased urination despite drinking
plenty of fluids, nausea, vomiting, and
shortness of breath.

63. Complications
Multiple Births
Birth defects

64. Aftercare
 After the IVF procedure is performed
the woman can resume normal
activities. A pregnancy test can be
done approximately 12-14 days later
to determine if the procedure was
successful.

65.  Women who undergo IVF must take
daily shots or pills of the hormone
progesterone for 8 - 10 weeks after
the embryo transfer. Progesterone is
a hormone produced naturally by the
ovaries that helps thicken the lining of
the womb (uterus). This makes it
easier for the embryo to implant. Too
little progesterone during the early
weeks of pregnancy may result in a
miscarriage.

66. ROLE OF NURSE IN
INFERTILITY
MANAGEMENT
 ASSESSMENT
 The nurses role during this stage is to
educate the couple about each test
and investigation, including why and
how this investigation to be
performed.
 The nurse plays a vital role in
alleviating the fear and anxiety about
the various diagnostic procedure.

67.  TREATMENT
 The nurse plays the link between the
doctor and couple and should always
be available to couple for their
assistance , guidance and support
before . during and after infertility
treatment.
 Numerous ethical issues are
associated with infertility treatments
and the couple under going treatment
need appropriate counseling and
discussion.

68.  EDUCATION
 The role of nurse in
educating the patients
includes education about the
basic male and female
anatomy and physiology and
how the drug acts on their
body, including possible side
effects.
 Fertility nurse should also
educate the couple about self
administer medications.

69.  PREVENT infertility by
 Avoid gonadotoxins
 Decrease exposure to occupational
and environmental hazards
 Avoid transmission of STDs by limiting
the number of sexual parteners and by
using condoms
 Eating a well balanced and nutritious
diet.
 Stopping smoking and drinking.

70.  PSYCHOLOGICAL SUPPORT
 A couple undergoing infertility
treatment are usually stress due to a
variety of reason. Because infertility
evaluation and treatments are
expensive , time consuming ,invasive
,stressful and not always successful
and also not socially acceptable.
Proper emotional support and
guidance is required by the couple at
this stage.

71.  The nurse as a counselor should
provide anticipatory advice and
guidance about the normal range of
expectations and reasons throughout
the treatment.

72. Any question ?

75. THANK
YOU