INFERTILITY IN FEMALE,Educational Platform.pptx

infertility

1. sir awal sher INFERTILITY IN FEMALE

2. Objectives At the end lecture the students will be able to INTRODUCTION of infertility Discuss Anatomy of female reproductive system Pathophysiology of infertility Risk factors of infertility Causes of infertility Sign and symptoms of infertility Clinical features , complication, diagnosis, prevention and treatment of infertility.

3. cont.… Medical management of infertility Nursing management of infertility

4. INTRODUCTION Average incidence of infertility is about 15% globally varies in different populations. Some cases can be detected and treated ,where as others cannot Unexplained infertility constitutes about 10% of all cases.

5. INFERTILITY DEFINITION: In general, infertility is defined as  not being able to get pregnant (conceive) after one year (or longer) of unprotected sex .

6. TYPES OF INFERTILITY Types of infertility include: Primary:  A woman who was never pregnant and who can’t conceive after one year of not using  birth control . Secondary:   Secondary infertility  occurs when a woman can’t get pregnant again after having at least one successful pregnancy .

7. Anatomy of female reproductive system Female reproductive system consists of the following parts: Labia majora :it enclose and protect the other external reproductive organs. Labia minora : It located inside the labia majora and surround the opening of vagina. Bartholin gland : These are located next to the vaginal opening and produce mucous. Vagina : A canal which joins the cervix to the outside body also called birth canal .

8. Cont … Uterus : A pear shaped organ which houses a developing fetus. It mainly has two parts , cervix : Lower part open into vagina and carpus ,upper part which expand to nourish the developing baby .It has three layers ,endometrium ,myometrium and perimetrium . Ovary : paired oval shaped organs which produce egg. Fallopian tube :Narrow tube which transport ova from ovary to uterus.

9. Pathophysiology of infertility Anovulation: women skips ovulation often due to hormonal immbalances.it thought to be due to excess LH i.e. LH:FSH ratio >3. Endometriosis: Most widely accepted hypothesis is that during endometriosis cell of endometrium are transported from uterine cavity and implanted at octopus side. Abnormalities in reproductive tract: Congenitive abnormalities :abnormalities in reproductive organs due to surgery or trauma etc. .damage to fallopian tube may also cause infertility .

10. Cont …. Problems in Hormones :some time pituitary or hypothalamus causes abnormality in hormonal secretion which cause anovulation difficult in maintance of pregnancy, not thickening of endometrium etc. . Immunological abnormalities : destruction of gametes by anti sperm antibiotics or anti ovary antibiotics diminished or layer ovarian reserve causes infertility.

11. RISK FACTOR FOR FEMALE INFERTILITY: Certain factors may put you at higher risk of infertility, including: Age: With increasing age, the quality and quantity of a woman's eggs begin to decline. Age (over age 35 for women or over 40 for men). Diabetes . Eating disorders , including  anorexia nervosa  and  bulimia . Excessive  alcohol  use. Exposure to environmental toxins, such as lead and pesticides. Over exercising.

12. Cont …. Smoking: Besides damaging your cervix and fallopian tubes, Smoking increases your risk of miscarriage and Ectopic pregnancy(a pragnancy in which the fetus develops outside the uterus,typically in a fallopian tube). Radiation therapy  or other cancer treatments. Sexually transmitted diseases  (STDs). Stress . Substance abuse . Weight problems ( obesity  or underweight).

13. Cont.. Weight: If you're overweight or significantly underweight, it may hinder normal ovulation. Sexual history: Sexually transmitted infections such as chlamydia and gonorrhea can cause fallopian tube damage. Alcohol: Heavy drinking is associated with an increased risk of ovulation disorders and endometriosis.

14. CAUSES OF INFERTILITY IN WOMEN Female infertility can be also be caused by a number of factors, including the following: Damage to fallopian tubes( utrine tube ). which carry the eggs from the ovaries to the uterus when damage can prevent contact between the egg and sperm. Pelvic infections and pelvic surgeries may lead to scar formation and fallopian tube damage.

15. cont... Hormonal causes. Some women have problems with ovulation. hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilized egg do not occur.

16. Cervical causes : A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure.

17. Cont … Uterus : A pear shaped organ which houses a developing fetus. It mainly has two parts , cervix : Lower part open into vagina and carpus ,upper part which expand to nourish the developing baby .It has three layers ,endometrium ,myometrium and perimetrium . Ovary : paired oval shaped organs which produce egg. Fallopian tube : Narrow tube which transport ova from ovary to uterus.

18. Sign And Symptoms The main symptom of infertility is the inability of a couple to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can be a sign of lack of ovulation

19. Cont … Signs of Potential Infertility in Women Abnormal periods. Bleeding is heavier or lighter than usual. Irregular periods. The number of days in between each period varies each month. No periods. You have never had a period, or periods suddenly stop. Painful periods. Back pain, pelvic pain, and cramping may happen.

20. Clinical Manifestation

21. COMPLICATIONS Age. Hormone issue that prevents ovulation. Abnormal menstrual cycle. Obesity. Being underweight. Having a low body-fat content from extreme exercise. Endometriosis. Structural problems (problems with the fallopian tubes, uterus or ovaries).

22. DIAGNOSIS AND TESTS Your healthcare provider may ask you to record signs of ovulation, such as  basal body temperature  and cervical mucus. You may also use a home ovulation kit. These tests can also help diagnose or rule out a female fertility problem: Pelvic exam:  Your provider will perform a  pelvic exam , including a  Pap smear  to check for structural problems or signs of disease. Blood test:  A blood test can check hormone levels, including thyroid hormones. Transvaginal ultrasound:  Your doctor inserts an  ultrasound  wand into the vagina to look for problems with the reproductive system.

23. CONT… Hysteroscopy:  Your provider inserts a thin, lighted tube ( hysteroscope ) into the vagina to examine the uterus . Saline sonohysterogram (SIS):  Your provider fills the uterus with saline (sterilized salt water) and conducts a transvaginal ultrasound. A full uterus makes it easier to see inside the uterus . Hysterosalpingogram (HSG):  X-rays capture an injectable dye as it travels through the fallopian tubes. This test looks for blockages . Laparoscopy:  Your provider inserts a laparoscope (thin tube with a camera) into a small abdominal incision.  Female pelvic laparoscopy  helps identify problems like endometriosis, uterine fibroids and scar tissue.

24. Prevention Maintain a healthy weight . Overweight and underweight women are at increased risk of ovulation disorders . Quit smoking. Tobacco has multiple negative effects on fertility, as well as your general health and the health of a fetus . Avoid alcohol. Heavy alcohol use may lead to decreased fertility . Reduce stress.

25. General treatment of infertility Fertility treatments for womenFertility drugs might be prescribed to regulate or induce ovulation.They include : Clomifene ( Clomid , Serophene ): This encourages ovulation in those who ovulate either irregularly or not at all, because of PCOS or another disorder. It makes the pituitary gland release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH ). Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance . Human menopausal gonadotropin, or hMG ( Repronex ): This contains both FSH and LH. Patients who do not ovulate because of a fault in the pituitary gland may receive this drug as an injection.

26. Cont … Follicle-stimulating hormone ( Gonal -F, Bravelle ): This hormone is produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles . Human chorionic gonadotropin ( Ovidrel , Pregnyl ): Used together with clomiphene, hMG , and FSH, this can stimulate the follicle to ovulate.

27. Cont …. Gonadotropin-releasing hormone ( Gn -RH) analogs: These can help women who ovulate too early—before the lead follicle is mature—during hmG treatment. It delivers a constant supply of Gn -RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH . Bromocriptine ( Parlodel ): This drug inhibits prolactin production. Prolactin stimulates milk production during breastfeeding. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems.

28. Medical management Treatments for infertility include: Medications:  Fertility drugs change hormone levels to stimulate ovulation. some medication for infertile women may include: Gonadotropins: The gonadotropins are peptide hormones that regulate ovarian and testicular function and are essential for normal growth, sexual development and reproduction. Metformin: Metformin lowers your blood sugar levels by improving the way your body handles insulin. It's usually prescribed for diabetes when diet and exercise alone have not been enough to control your blood sugar levels. For women with PCOS (Polycystic ovary hormones)(androgen), metformin lowers insulin and blood sugar levels, and can also stimulate ovulation.

29. Cont … Letrozole : It works by decreasing the amount of estrogen produced by the body. This can slow or stop the growth of some types of breast cancer cells that need estrogen to grow. Bromocriptine : Bromocriptine is in a class of medications called dopamine receptor agonists. It treats hyperprolactinemia by decreasing the amount of prolactin in the body. It treats acromegaly by decreasing the amount of growth hormone in the body. It treats Parkinson's disease by stimulating the nerves that control movement.

30. Surgical management Surgery:  Surgery can open blocked fallopian tubes and remove uterine fibroids and polyps. Surgical treatment of endometriosis doubles a woman’s chances of pregnancy. They include: Laparoscopic or hysteroscopic surgery. Surgery might involve correcting problems with the uterine anatomy, removing endometrial polyps and some types of fibroids that misshape the uterine cavity, or removing pelvic or uterine adhesions.

31. Cont …. Laparoscopy: is a surgical procedure that allows a doctor to see inside the body. When the procedure is part of fertility testing, the doctor is evaluating the structures of the reproductive system, including the ovaries, fallopian tubes, and uterus. Salpingectomy: is a surgical procedure where one or both of a woman's fallopian tubes are removed. It's performed to treat certain conditions of the fallopian tubes and ectopic pregnancies, and as a preventative measure for women at higher risk of developing ovarian cancer.

32. Natural Ways to Boost Fertility Eat foods rich in antioxidants. Antioxidants like folate and zinc may improve fertility for both men and women. Eat a bigger breakfast . Cut down on carbs if you have PCOS. Eat fewer refined carbs. Eat more fiber. Swap protein sources. Choose high fat dairy.

33. Epidemiology Infertility is a major disease worldwide. Globally, the highest incidence of infertility is found in Central and Southern Africa where as many as 1 in 3 women are infertile. Around 1 in 6 couples in industrialized countries seek medical advice on infertility. In the US, it is estimated that 2.1 million married couples are affected by infertility. In 2002, it was reported that 12% of women had received infertility services at some time in their lives.

34. cont.... Female etiologies are present in 42.2% of cases, male etiologies in 18.8% of cases, combined male and female etiologies in 17.8% of cases, and unexplained etiology in 13.6% of cases.

35. Assessment Assess alcohol, drug and tobacco use . Assess any exposure to radiation treatment in the past . Assess current illnesses, especially endocrine diseases . Assess occupation and work habits . Assess the couple’s sexual practices, its frequency, and if there are failed ejaculations . Assess the use of past and present contraceptive measures . Assess if there are any children from previous relationships . Assess current health of the reproductive system.

36. Nursing diagnosis Anovolution related to hormonal imbalance. Blockage of fallopian tube related to endometriosis. Menopause related to age As manifested by no monthly periods Polycytic ovary syndrome related to obesity Pelvic inflammatory disease related too obesity as manifested by scarring of fallopian tube Fever Being underweight

37. Nursing planning Use surgical procedure to treat endometriosis. Medication to treat hormonal imbalance. Hormonal therapy. Fertility drug administration. To educate patient Counseling Advice for assistant techniques.

38. Nursing Intervention Administered antibiotic for the treatment of infection. Administered fertility drug to regulate the fertility Educate the women to mantain normal weight before the pragnancy Teach the women to minimize stress and anxiety which are the cause of infertility

39. Evaluation Test for pregnancy Check amount and balance for hormones in female. X ray of fallopian tube to check success of endometriosis. Ovalvation test : A blood test measure hormones to determine that whethere you are evaluating now or not. Special ultrasound test etc.

40. References Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility. Fertil Steril . 2008;90( suppl 5):S254-S259Eichener SF, Timpe EM. Urinary-based ovulation and pregnancy: point-of-care testing. Ann Pharmacother . 2004;38:325-331 .. Brunner's and suddarths Textbook of medical surgical nursing https://familydoctor.org/condition/infertility / https://www.cdc.gov/art/whatis.html