infertility.pptx

Infertility

1. infertility Presented by – Preeti Kulshrestha M.Sc. Nursing previous year

2. Definition Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12th month or more of regular unprotected sexual intercourse.

3. Types . infertility Primary infertility Secondary infertility

4. Contd. Primary infertility – it denotes those patients who have never conceived . Secondary infertility – It indicates previous pregnancy but failure to conceive afterwards.

5. incidence Male - 35% Female - 35% Both - 20% Unknown - 10% This problem affects 1 in 7 couples.

6. causes

7. Faults in male Defective spermatogenesis Obstruction of the efferent duct system Failure to deposit sperm high in the vagina Errors in the seminal fluid

8. Contd. 1. Defective spermatogenesis – Orchitis Undescended testis (cryptorchidism) Genetic or chromosomal disorders like 47, XXY Endocrinal factors e.g. thyroid dysfunction ( abnormalities of thyroid gland )

9. Contd. 2. Obstruction of the efferent duct system : It can be of two types - a. Congenital = it can be due to absence of vas deferens. b. Acquired = it can be due to infection - tuberculosis - gonorrhea - surgical trauma

10. Contd. 3. Failure to deposit sperm high in the vagina – Impotency Ejaculatory failure hypospadiasis bladder neck surgery psychosexual

11. Contd. 4. errors in the seminal fluids – aspermia/ azoospermia (failure to produce semen or absence of sperm in semen) oligospermia/ oligozoospermia (few sperm in semen) Asthenospermia (reduced sperm motility) Necrozoospermia (dead sperm ) Teratozoospermia (sperm with abnormal morphology) Polyzoospermia (sperm counts >250 million/ml)

12. Fault in female Ovarian factor Tubal factors Peritoneal factors Uterine factors Cervical factors Vaginal factors

13. Contd. 1.ovarian factors – Anovulation / oligo-ovulation (lack or absence of ovulation) Luteinized unruptured follicle (luf) – inadequate growth and function of corpus luteum.

14. Contd. 2. Tubal factors – Salpingitis (tubal infection) 3. Peritoneal factors – Endometriosis 4. Vaginal factors – Vaginal atresia (closed vagina) Vaginal septum (female reproductive system does not fully develop)

15. Contd. 5. Uterine factors – Fibroid uterus Uterine hypoplasia Abnormal / irregular menstrual cycle congenital malformation of uterus Retroverted uterus

16. Contd. 6. Cervical factors – Congenital elongation of cervix Second degree uterine prolapse combined factors It may include both male and female factors.

17. Clinical manifestation In male – Changes in hair growth Changes in sexual desire Pain or swelling in the testicles Small, Firm testicles Problem with sexual function Difficulty with ejaculation Having a low sperm count

18. Contd. in female – Abnormal periods Irregular periods No periods Painful periods Skin change including more acne Changes in sex desire Dark hair growth on the lips, chest, and chin Weight gain Pain during sex

19. Risk factors For all genders Over Age (35 for female or 40 for men) Smoking Over weight Over exercise Sexually transmitted disease Mental stress Diabetes Eating disorder (anorexia nervosa and bulimia) Excessive alcohol use Radiation therapy or other cancer treatments

20. Diagnostic procedures In males – 1.History – age of marriage, duration Medical history (any d/s) Surgical history (any genital tract surgery, testicular surgery) Occupational history (exposure to radiation, excessive heat) Smoking and alcohol Sexual history (frequency, impotency, lack of satisfaction)

21. Contd. 2. Examination – a. Inspection = whole genital area b. Palpation = testis, genital area, testicular volume is checked with the help of orchidometer.

22. Contd. 3. General investigation – a. Semen analysis sperm volume Sperm count Ph-7.2 to 7.8 Sperm concentration Sperm motility

23. Contd. b. Hormonal studies or special investigation c. In-depth evaluation – Serum fsh Serum lh Testosterone Tsh Prolactin levels Testicular biopsy high Defect in testis

24. Contd. in female – 1.History – Previous infertility Medical history Surgical history Menstrual history Previous obstetric history Use of contraceptives Sexual history

25. Contd. 2. Examination – a. General examination – obesity Over weight Underweight Abnormal distribution of hair (axillary and pubic) Decreased secondary sex characteristics

26. Contd. B. systemic examination – to detect – hypertension Organic heart disease Renal problem endocrinopathies ( disease of endocrine gland)

27. Contd. c. Gynecological examination – Evidence of vaginal infection Adequacy of hymenal examination Cervical tear or chronic infection Undue elongation of cervix Uterine size, and position

28. Contd. d. Speculum examination – To check abnormal cervical discharge . if present, it is sent for screening.

29. treatment In male – a. Medical management – If the infertility is due to hypogonadotrophin – hypogonadism - tab. Clomiphene citrate = 25-50 mg orally DAILY for 25 days with rest for 5 days into 3 cycle. It helps to increase the serum level of fsh, lh and testosterone. - inj. Hcg(human chorionic gonadotropin ) = 5000 Iu, I/m ( once or twice a week). It will stimulate the endogenous (internal) testosterone production. - inj. Hmg(human menopausal gonadotrophin) = used in failed clomiphene citrate condition. - tab. Testosterone = 100-160 mg orally daily for 3-4 months. It helps in increasing the sperm count.

30. Contd. GTI = ANTIBIOTICS (DOXYCYCLINE, ERYTHROMYCIN) FOR 4-6 WEEKS. HYPOTHALAMIC DYSFUNCTION = GNRH THERAPY IS GIVEN TERATOSPERMIA OR ASTHENOSPERMIA = NO TREATMENT, ONLY DONOR INSEMINATION IS AVAILABLE. EJACULATORY PROBLEMS = PHENYLEPHRINE IS USED . IT IMPROVES THE TONE OF INTERNAL URETHRAL SPHINCTER AND THE MUSCLES .

31. Contd. B. surgical management – Obstruction in vas = vasoepididymostomy or vasovasostomy is done. Varicocele = corrected by high ligation of spermatic vein. Hydrocele = corrected by the surgery Undescended testis = orchidopexy at the age of 2-3 yrs.

32. Contd. c. Nursing management – Improve the general health of the patient. Reduce weight, if the person is obese. Tell to avoid heavy smoking and alcohol. To avoid tight and warm undergarments. Encourage the pt. to take cold scrotal bath at least twice a day for 5 min. To take vitamin e, c, b12 and folic acid as they improve spermatogenesis. Give the pt. psychological support Advice and teach the couple about the proper technique of intercourse.

33. Contd. In female – a. Medical management – if the infertility is due to ovulatory disorders, then – T. Clomiphene citrate Inj. hmg Hypothalamic disorder/amenorrhea/hypogonadotrophin/ hypogonadism – Gnrh therapy is given Defective folliculogenesis – inj. Hcg 5000iu: 10000iu i/m is given Vaginal suppositories100mg tds Hyperprolactinemia – bromocriptine therapy may given.

34. Contd. b. Surgical management – tuboplasty – to repair the tubes Salpingostomy – creation of an opening into the fallopian tube Adhesiolysis(salpingo-ovario-lysis) procedure performed to break up and remove adhesions. Tubotubal anastomosis – when the segment of the tube is diseased. Tubal cornual anastomosis – in case of cornual block. Cannulization of the tube – in case of tubal obstruction myomectomy – surgical removal of uterine fibroids.

35. summary Infertility is a significant social and medical problem affecting couples worldwide. Female and male factors are equally responsible . Evolution of both partners is essential . Treatment depends on the cause of infertility and varies from ovulation- inducing drugs to surgery to art.

36. bibliography D. c. Dutta, textbook of gynecology, new central book agency (p) ltd edition 5th page no. 220-234 dr. shally magon – sanju sira textbook of midwifery and obstetrics lotus publishers, edition 4th, page no 875-882