INFERTILITY AND ITS MANAGEMENT

INFERTILITY AND ITS MANAGEMENT IS A LIGHTNING TOPIC OF OBSTETRICS AND GYNAECOLOGY. ALL THE METHODS OF INFERTILITY MANAGEMENT ARE DISCUSSED IJN THIS SLIDE.

1. CLASS PRESENTATION ON :-
INFERTILITY AND ITS
MANAGEMENT
:-PRIYANSHU ANAND
B.ScNursing 4
th
Year
O.I.N.S.R. DAMOH (M.P.)

2. :-
•INTRODUCTION TO INFERTILITY
•DEFINITION OF INFERTILITY
•TYPES OF INFERTILITY
•ETIOLOGY/CAUSES
•RISK FACTORS
•DIAGNOSTIC INVESTIGATIONS
•MANAGEMENT OF INFERTILITY
•PREVENTION OF INFERTILITY

3. :-
•Infertilityadiseaseofreproductivesystem
duetowhichthecouplesareunabletohave
child.
•Theinabilitytohavechildaffectscouplesand
causesemotionalandpsychologicaldistressin
bothmenandwomen.

4. •Despitethevarioussocial,psychological,
economicandphysicalimplications,infertility
preventionandcareoftenremainsneglected
publichealthissuesoratleasttheyranklow
ontheprioritylist,especiallyforlow-income
countriesthatarealreadyunderpopulation
pressure.

5. According to World Health Organization,
“Infertilityreferstoinabilitytoachieve
pregnancyafter12monthsofhaving
unprotectedsexualintercoursewithaverage
frequencyof3-4timesperweekwithoutuse
ofanybirthcontrolmeasures.”

6. INFERTILITY
PRIMARY
INFERTILITY
SECONDARY
INFERTILITY

7. •PRIMARYINFERTILITY:-Itmeansthatthe
couplehasneverconceivedearlier.Globally
mostcouplessufferfromthistypeof
infertility.
•SECONDARYINFERTILITY:-Itmeansthatthe
couplehasexperiencedapregnancybefore
andfailedtoconceivelater.

8. 1.MALE FACTORS:-
–Defective Spermatogenesis
–Obstruction of efferent duct
–Failure to deposit sperm
–Seminal fluid errors

9. 2. FEMALE FACTORS:-
–Ovarian factors
–Uterine Factors
–Cervical factors
–Vaginal factors
–Tubal and peritoneal factors
–Combined factors

10. 3. FACTORS INFLUENCING BOTH SEXES:-
–Environmental/ Occupational factors
–Toxic effects due to tobacco, alcohol, drugs, etc.
–Excessive exercise
–Inadequate diet associated with extreme weight
loss or gain
–Advanced age.

11. •Age
•Smoking
•Over-weight
•Over-exercise
•STDs
•Frequency and timing of sexual intercourse
•Mental stress

12. Asweknowthatbothmaleandfemalefactors
cancontributetoinfertility.Tocheckfor
infertility,followingtestsaredone:-
•HISTORYTAKING:-Couplesareinterviewed
separatelyortogethertoknowaboutcausesof
infertility.Fullhistoryincludes:presenthistory,
menstrualandobstetrichistory,contraceptive
andsexualhistory,familyplanningandpast
history.

13. •CLINICALEXAMINATION:-Fullclinical
examinationofbothpartnersisrequiredfor
detectionofanyphysicalproblem.Itincludes
generalexaminationalongwithexaminationof
chest,breast,abdomenandgenitalia.
•INVESTIGATIONS:-Infertilecouplesareusually
advisedtostarttheirinvestigationsafter12
monthsoftryingtoconceiveorafter6weeksif
thefemalepartnerismorethan35yearsofageor
immediatelyifthereisanobviouscausefortheir
infertility.

14. Investigations include the following :-
SEMENANALYSIS:-Itshouldbedoneafter72hours
ofsexualabstinenceandtwoanalysisshouldbe
advisedwithin3monthsapartatthesamelab.
Resultsmaybeinterpretedforitsvolume,sperm
count,motilityandmorphology.
Investigations for female partner include :-
oDetection of ovarian functions
oHormonal Assay:-FSH and LH levels and mid-
lutealprogesterone levels.

15. oTransvaginalUltrasonography:-Itisusedfor
detectionofovulationinfemalesandany
abnormalityinuterusandadnexa(adjoining
anatomicalpartsoftheuterus).
oEvaluation of tubal patency
(HYSTEROSALPINOGRAPHY)(HSG):-It’sa
radiologicprocedure.Thedyeisinsertedintothe
uterusthroughcervixandsimultaneouslyx-ray
picturesaretakentoseethemovementofdye
intothefallopiantubes.Spillingofdyesinto
abdominalcavityshowsthattubesarepatent.

16. Advancedinvestigationsinclude:-
oHormonalAssay:-Thyroidfunctiontest,prolactin
level,testosteroneandothertestsifpolycysticovary
syndromeissuspected.
oLaparascopy:-Itisasurgicalprocedureusedto
visualizeabdominalandpelvicorgans.
oHysteroscopy:-Itisindicatedforintrauterinespace-
occupyinglesionsdetectedonHSG.
oChromosomalKaryotyping:-Forsuspectedgenetic
disorders.
oTesticularBiopsy:-Afineneedleaspirationbiopsyto
differentiatebetweenobstructiveandnon-obstructive
azoospermia.

17. Management of infertility ranges from
counsellingand advice to medications and
surgery.
General instructions for management are:-
•Maintainanceof body weight.
•Avoid smoking and alcohol.
•Maintain ideal coital frequency (3-4 times/week).

18. •Avoid use of contraceptives.
•Avoid fertility impairing medications.
•Psychological support.
•Promote regular exercise.
•Folic acid supplementation in women.

19. Apart from these general instructions
following are the management methods for
infertility :-
Management
Medical
ARTSurgical

20. Medical Management:-
•Estrogen modulators
•Anti-diabetic meication
•Hormonal medication

21. Surgical management:-
•Surgical removal of tumor
•Balloon tuboplasty
•Fimbrioplasty
•Adhesionolysis

22. ART (Assisted Reproductive Technique)
“Itinvolvesdirectretrievalofoocytesfrom
ovary,manipulationofgametesandembryos
outsidebodyforpurposeofestablishing
pregnancy.”

23. Some techniques of ART are :-
•IUI(IntrauterineInsemination):-IUIisthe
placementofmen’sspermintoawoman’suterus
usingalongnarrowtube.Itmaybeusedin
conditionssuchasdefectsofcervix,lowsperm
count,spermwithlowmotility,erection
problems,etc.
–It is of two types :-
1.Artificial insemination by husband (AIH)
2.Donor Insemination

24. •IVF(Invitrofertilization):-Inthis,eggsand
spermsaretakenfromthecoupleandare
incubatedtogetherinadishinalaboratoryto
produceanembryo.Medicalspecialistsplace
theembryointothewomen’suterus,whereit
mayimplantanddevelopsuccesfulpregnancy.

25. •GIFT(GameteIntrafallopiantransfer):-Inthis
procedurefertilizationoccursnaturallyafter
eggsandspermsareplacedinsidethe
fallopiantube.
•ZIFT(Zygoteintrafallopiantransfer):-InZIFT,
fertilizedeggsaretransferredtofallopian
tubeswithin24hoursafterfertilization.

26. •ICSI(Intracytoplasmicsperminjection:-inthis
proceduresinglespermisinjectedintothe
matureeggitisusedtotreatspermrelated
infertilityproblems.
•Surrogatecarriers:-Awomeninseminated
withspermfrommalepartnerofthecoupleit
isusedwhenthefemalecoupledoesnot
producehealthyeggsthatcanbefertilized

27. •Gestationalcarriers:-inthiswomencarrieris
implantedwithanembryothatisnot
biologicallyrelatedtoheritsusedwhen
femalecoupleproduceshealthyeggbutis
unabletocarrypregnancytoterm.

28. PREVENTION OF INFERTILITY
•Weight management.
•Eat a balanced diet.
•Participating in moderate exercise.
•Making time for leisure and enjoyment.
•Illegal drugs such as marijuana or cocaiveshould be
avoided.
•Practice safe –sex.
•Keep in mind about the fertility ages of women.

29. THANK YOU