Female infertility

NURSING

1. FEMALE INFERTILITY

2. DEFINITION Infertility is defined as a failure to conceive within one or more years of regular unprotected coitus

3. TYPES PRIMARY SECONDARY

4. Natural conception rates: 80% of couples will be pregnant after 12 cycles. 50% of remaining will conceive during a 2nd year ( hence cumulative rate 90%) 50% in the following 4 years.

5. CAUSES

6. FEMALE FACTOR GENETICS &IMMUNOL IATROGENIC FACTOR OVARIAN FACTOR TUBAL AND PERITONEAL FACTORS UTERINE FACTOR CERVICAL FACTOR VAGINAL FACTOR COMBINED FACTOR

7. INVESTIGATION

8. FEMALE INVESTIGATION INDIRECT MENSTRUAL HISTORY BBT HORMONEAL ESTIMATION CERVICAL & VAGINAL CYTOLOGY ENDOMETRIAL BIOPSY SONOGRAPHY DIRECT RUBIN TEST HYSEROSALPINGOGRAPHY LAPROSCOPY

9. INDIERCT

10. Management in primary care Lifestyle changes - Weight reduction, BMI 19-29 - Smoking cessation- offer support groups - Alcohol reduction <1-2 units/week for women <3-4 units/week for men - S I every 2-3 days - Information about OTC/ recreational drugs

11. Management in primary care Pre conceptual advice - Folic acid supplementation - Rubella status - Cervical screening Management of erectile dysfunction - psychosexual couselling - drugs

12. Management in secondary care Depends upon the etiology..

13. Hypogonadotrophic hypogonadism Pulsatile GnRH Gonadotrophins with LH activity Bromocriptine ( for hyperprolactinaemia )

14. Ovarian dysfunction ( hypothalamic dysfunction) 1) Anti- oestrogens eg Clomiphene / Tamoxifen - 1 st line - use for atleast 12 months if ovulating - initiated in secondary care - under USG guidance ( to adjust dose) - shared care when dose established - S/E risk of multiple pregnancy, OHSS

15. 2) Metformin 3) Gonadotrophins 4) Luteal phase support – - progesterone, - clomiphene 5) Laparoscopic ovarian drilling

16. Uterine/ tubal factors Tubal factors: - Laparoscopic tubal surgery/ tubal microsurgery - Salpingography + tubal catheteristion - Hysteroscopic tubal cannulation Uterine factors - hysteroscopic adhesiolysis - myomectomy

17. Peritoneal problems (endometriosis) Laparoscopic surgical ablation/ resection of endometriosis + adhesiolysis If ovarian endometriomas , laparoscopic cystectomy

18. Assisted reproduction techniques Intra uterine insemination (IUI)

19. In vitrio fertilisation

20. SURROGACY

21. THANKS