INFERTILITY. pptx Gynecology and Obs

Education

1. MANAGEMENT OF CLIENTS WITH INFERTILITY PROBLEMS  

2. At the end of the lecture, students are expected to: Define infertility Explain the causes of infertility to both males and females Manage a clients with infertility

3. Infertility absolute state of inability of a couple to achieve conception within one (1) year or more of regular and un protected sexual intercourse. OR Infertility is the inability to conceive and carry a pregnancy to viability after one (1) year of regular sexual intercourse without contraception Sub infertility is a relative state of lowered capacity to conceive

4. Types of infertility Primary infertility : carried to alive birt h: is inability to conceive and carry a pregnancy to viability with no previous history of pregnancy Secondary infertility : It is where there has been previous pregnancy irrespective of the outcome.

5. Causes of infertility Men Defective spermatogenesis Dysfunction of: hypothalamus, pituitary gland, adrenals and thyroids Systemic diseases : diabetis mellitus and renal failure

6. Testicular disorders & inflammation Trauma Environmental ( high temperature) congenital (hydrocele, undescended testes) occupational (fernacemen, long-distance truck/ lorry drivers) acquired (varicocele, tight clothing) Cancer treatment- radiation exposure

7. Defective transport Obstruction or absence of seminal ducts : Infection Congenital anomalies Trauma

8. Impaired secretions from prostate or seminal vesicles: Infections Metabolic disorders

9. I neffective delivery psychosexual problems/ stress drugs Inadequate sperm production and maturation Inadequate motility of the sperm

10. Sexually transmitted diseases Failure to depose spermatozoa in the vagina

11. Females Vaginal- abnormalities Infections- causing dyspareunia Highly acidic vaginal( PH) Congenital anomaly

12. Cervical –Hostility environment( insufficient oestrogen or infection)-mucus hostility Incompetent cervix, trauma, infections, antisperm antibodies in the mucus Uterus – abnormalities- hostile environment for implantation and survival of blastocyst Tubal – adhesions, scar tissue due to PID, previous tubal surgery leading to defective transport

13. Defective implantation due to : hormonal imbalance, congenital anomalies, fibroids and infection Ovarian disorders- irregular infrequent ovulation, hormonal defect, ovarian cysts or ovarian diseases Systemic conditions- diabetis mellitus, renal failure

14. Defective ovulation due to endocrine disorders from dysfunctioning of the: hypothalamus, pituitary gland, adrenal glands and thyroid gland Co ital errors- dyspareunia , frequent untimming coitus, use of lubricants of which some are spermicides

15. Defective ovulation due to Endocrine disorders thus dysfunction of : hypothalamus, pituitary,adrenals,thyroid Unexplained infertility

16. Investigations - both partners should be involved History History of regular un protected sex for one year and above, age (too young or too old, occupation, duration of marriage, bleeding pattern and any previous pregnancy. Medical / surgical history , operations, infections, if normal coitus Menstrual history, menstrual cycle, any dysmenorrhea, duration of bleeding and use of contraceptive

17. History of drug therapy Duration of marriage Social history-alcohol intake

18. Examination & investigations Physical examination to rule out any physical abnormalities-attention to the genital , uterus, size , location, mobility, fixation, Vagina Males- penis for any abnormalities

19. Semen analysis (normal values .WHO). Submitted specimen to reach the laboratory within 2 hours. -semen volume >2-5ml -sperm concentration >20million/ml -mortality> 50%progressive mortality - Morphology >30%normal forms -white blood cells <1 million /ml

20. Abnormalities is opposite of the above including necrospermia (dead sperms) and Azoossparmia( no sperms) The post coital test- glass slide smear to check for sperms Serum progesterone test Endometrial biopsy Hysterosalpingingram Laparoscopy

21. Culdoscopy Robins test Asses for patency of the tubes for blockage D& C in the secretory phase and send specimen for histology

22. Management of infertility There is no universal treatment or cure for infertility. In general, treatment depends on the specific cause of infertility for that couple. The majority of couples who seek advice, testing and treatment for infertility do conceive. About 50% of the women become pregnant with 12 - 18 months of starting investigation

23. Treat the cause as per history, examination and investigations Initial visit : The initial encounter with the infertile couple is the most important to outline the general causes of infertility and to discuss the subsequent evolution.

24. Obtain complete medical, surgical and in addition to the female partner include: gynecologic and obstetric history. -Important points in history include: - do they have child? (Together or alone), - regularity of menstrual cycle, - adequacy of sexual intercourse.

25. The couple should have sexual intercourse every two days during the fertile portions of the woman's cycle, which is determined. risk factors for infertility such as: - history of PID - use of IUD - history of pelvic surgery - history of endocrine disorder like pituitary, adrenal and thyroid function. • Obtain information regarding genital surgery, infection, trauma, history of mumps for the male partner.

26. Assess emotional impact of infertility on the couple and counsel accordingly. During this visit, do through physical examination with particular attention to height, weight, body habitus, hair distribution, thyroid gland and pelvic examination. If any abnormalities which need further evaluation are detected on pelvic examination, refer to higher center. But if no abnormalities, were detected on physical examination including speculum examination, explain to the client the basic requirements

27. Basic requirements for women Woman must be ovulating (look for evidence of ovulation). The tubes that connects the uterus with ovary should be patent (assessment of patenc) is done by hysterosalphingo graphy (HSG). The lining of the uterus should be healthy and appropriate for implantation

28. Basic requirements for men The man must be able to have adequate erection and ejaculate sperm. The sperm must be fertile and there must be enough sperm present. The tubes which transport; sperm from tests to penis should be healthy and patent. Plan regular return visits for the couple if appropriate .

29. Drugs To induce ovulation ( amenorrhoea,oligomenorrhea and where partner has adequate sperm) give Clomiphene 500mg at 2 nd day of the cycle,3 rd ,4 th and 5 th .Then start coitus up to 26 th -27 th Bromcriptine can also be administered.2.5 mg to induce ovulation and suppress prolactin. Administer folic acid and b-complex for 3 months in low spermatozoa. Administer appropriate antibiotics to treat infections Refer to endocrinologists if there is hormonal imbalance for possible hormonal therapy

30. Assisted reproduction techniques Intrauterine insemination ( IUI) Un explained infertility Hostile cervical mucus Antisperm antibodies Ensure ovulation takes place before sperm is inserted high in the vagina

31. Donor insemination (DI) Sperm from an anonymous donor is used and may be indicated in the following: Azoospermia Oligospermia Vasectomy Ejaculatory Chemotherapy or radiotherapy Transmissible genetic disorder

32. In Vitro fertilization/ embryo transfer (IVF/ET) It is a technique where fertilization takes place outside the body The suitable oocytes and prepared spermatozoa are incubated .After successful fertilization, one or two embryos are transferred in to the woman’s uterus Any remaining embryo are frozen for future use

33. Intracytoplasmic sperm injection(ICSI) It involves injecting a single spermatozoon in an ovum Sperms are prepared in such a way that the most motile of these can be selected Very useful technique when there are very few normal sperms available or the fertilising ability of the sperm is dramatically reduced

34. Surgery Removal of some adhesions Repair of any damaged organs/tissue(tubal surgery)

35. Counselling Counselling: When no obvious cause can be found for infertility counseling may improve the couples chance of achieving pregnancy. Advice of general health Regular exercise Avoid excessive drinking alcohol and smoking .

36. And the couple should also be taught how to identify the most fertile phase in the menstrual cycle when sexual intercourse is most likely result in pregnancy. Continue normal sexual habits Prevent stress. Associate and share with other couples with similar problems Possible adoption

37. Psychosocial aspect of infertility Guilty Anger Depression Anxiety Inadequacy Grief

38. Loss of control Low self esteem Relationship difficulties Isolation Divorce Strengthen relationships with other couples who are infertile  

39. Assignment Write short notes on the following Surrogacy Psychosexual aspect of infertility