Infertility

Content of Infertility

1. INFERTILITY PRESENTED BY, SONAL PATEL

2. Terminology TERM NAME DEFINITION Fertility It is the ability to conceive Sterility It is an absolute inability to conceive Fecundity It is the ability of a man and a woman to reproduce.

3. INFERTILITY

4. Definition “Infertility is failure to conceive after one year of unprotected regular sexual intercourse with average frequency (2-3 times / week )”. -NICE guideline, CG156

5. Type(Classification) Primary infertility: Difficulty to conceive for couple who has never before had a child. Secondary infertility: W oman has previously been pregnant regardless of the outcome of the pregnancy and now unable to conceive.

6. Factors involved in fertility: Frequency/Timing of sexual intercourse: Every 2 to 3 days optimizes the chance of pregnancy. Frequency of intercourse 1 time per week 3 time per week Probability of conception(within 6 months) 17% 50%

7. Obesity: - Women who have BMI of over 30 that to take longer to conceive and will affect treatment success rates . Low body weight -Women with BMI less than 19 and irregular menstruation should be counselled to gain weight. Factors involved in fertility:

8. Smoking - Strong association between smoking and fertility in both partners . Affects success rates of ARTs . Tight underwear - E levated scrotal temperature and reduced semen quality. Factors involved in fertility:

9. Alcohol - Female patients should be informed that 1 or 2 units of alcohol once or twice per week reduces risk of harming a developing fetus . - Intoxication may affect semen quality. Prescribed , over-the-counter and recreational drug use Occupation Factors involved in fertility:

10. Causes of Infertility :

11. Female causes :( 30- 40%)

12. Female causes:(Cont)

13. Hormonal Problem

14. Scarred Ovaries

15. Premature Menopause- Low Body Weight

16. Follicle Problems- Unruptured Follicle Syndrome

17. Endometriosis

18. Female causes:(Cont)

19. Infection Hydrosalpnix

20. Abdominal Disease

21. Previous Surgeries

22. Ectopic Pregnancy

23. Congenital Defects

24. Female causes:(Cont)

25. Female causes:(Cont)

26. Female causes:(Cont)

27. Male Causes : (30- 40%) testicular 33%

28. Male Causes : 1. Hormonal Problems

29. Male Causes : 2. Physical Problems

30. Varicocele

31. Damaged Sperm Ducts

32. Torsion

33. Infection & Disease

34. Klinefelter’s Syndrome

35. Retrograde Ejaculation

36. Male Causes : 3. Psychological/Behavioral Problems

37. Erectile Disfunction (ED)

38. Premature Ejaculation

39. Ejaculatory Incompetence This rare psychological condition prevents men from ejaculating during sexual intercourse even through they can ejaculate normally through masturbation.

40. Semen Analysis Produced by masturbation after 2-7 days of sexual abstinence Do not use lubrication 2 to 3 samples required; additional if abnormal Protect against extreme temperatures (< 20C / >40 C) Analysis within one hour of collection Volume – 2 ml or more, pH - 7.2 or more

41. Cont… To Pinpoint the cause of Infertility, a variety of other tests may be performed :

42. Treatment for Male Infertility

43. 1. Treating Hormonal Problems

44. 2. Treating Physical Problems Sperm retrieval Methods :

45. Cont…

46. 3 . Treating Psychological Problems

47. Diagnostic Test

48. Diagnostic Test Tests of Ovulation Ultrasound testing Luteal phase testing is conducted to assess whether the uterus prepares itself properly to receive & carry a fertilized egg, blood tests (determine hormone levels), an endometrial biopsy (to observe the development of the uterine lining.) Step One

49. Diagnostic Test E valuate the quantity, motility & shape of sperm. If initial analysis indicates a low sperm count, abnormal sperm shapes, or low sperm motility, additional analysis may be performed, including penetration tests or the hemizona test. The Hemizona A ssay T est/ Hamster Test determine capability of sperm to penetrate egg during IVF.

50. Diagnostic Test Tests Cervical Functioning, using the post-coital test to assess if there is a problem in the interaction between a woman’s cervical mucus and her partner’s sperm. Step Three

51. Diagnostic Test Post-coital test (PCT): ( Sim ’ s Huhner test) Scheduled around 1-2day before ovulation (increased estrogen effect) 48 hour of male abstinence before test. No lubricants. Evaluate up to 8-12 hours after coitus. Remove mucus from cervix (forceps, syringe) which is placed on a glass slide and then examined under a microscope. A P ositive test will show reasonable numbers of actively motile sperm. Indicating good cervical insemination.

52. Diagnostic Test

53. Diagnostic Procedures

54. Drugs Ovulatory disorders are involved in about 40% of fertility problems.

55. Intrauterine Insemination-IUI (Artificial Insemination) 70-90% success rate. Semen used is filtered for washing.

56.  A procedure in which a fine catheter (tube) is inserted through the cervix into the uterus to directly deposit a sperm sample. The purpose of procedure is to achieve fertilization and Pregnancy. Definition

57. Indication Cervical Problem Mechanical Problem such as spinal cord injury & other Physical Disability. Antisperm Antibody in the man Mild Oligospermia with satisfactory motility Semen stored before starting of chemotherapy or radiotherapy.

58. Indication for Donor Insemination Azospermia or Oligospermia in male Partner. Excessive non-motile or abnormal sperm. Risk of transmission of a hereditary disease. Rh-isoimmunization, a rheses negative donor can be used. Lack of male Partner.

59. Selection of Donor Must be of normal intelligence, fit & healthy with no personal or Family History of diseases. Test for STD including HIV are repeated at every visit. The semen is frozen & stored for at least 3 months before use to be sure & tests were negative. Donor are matched as for as possible to the male partner skin, hair, aye coloring, height build, & blood group. The couple requesting Artificial Insemination Signs an informed consent & a contract accepting the resultant offspring as their legal hair. Donor is not considered as father.

60. Procedure With the use of Vaginal Speculum & Syringe the ejaculate is deposited into the cervical canal or vaginal vault . Kept in the Place with a diaphragm or cervical cap for 8 hours. The women may be asked to lie still for a few minutes. It is usually carried out 2-3 days before the ovulation, 2-3 Inseminations may be required with in one month cycle, the process may continue for 6-12 months until pregnancy occur.

61. In Vitro Fertilization/Embryo Transfer/Test Tube Conception

62. Definition 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 at end of 48-72 hours.

63. Tubal Damage Oligospermia, Poor motility Endometriosis Pelvic Inflammatory diseases Absence or diseases uterus Idiopathic Infertility Indication

64. Preparation of the Patient

65. Procedure

66. Cont…

67. Risks of IVF

68. Advantages

69. Disadvantages Multiple Births (50%) Babies are born early & weight less.

70. Nurses Role Assess the women’s Condition. Give Guidance regarding the ART Procedure. Sent for the Counseling Center. Provide psychological support for the women’s. Explain the procedure a formed in the infertility treatment.

71. THANK YOU