Infertility slideshare

For nursing students

1. INFERTILITY PRESENTED BY Miss Daminee Patel

2. DEFINITION Infertility is define as failure to conceive after 1 year of unprotected sexual intercourse. Lippin cott Infertility is strict define as the inability to conceive after one year of unprotected regular sexual intercourse. D.C.Dutta

3. INCEDENCE OF INFERTILITY

4. FACTORS CONTRIBUTING TO INFERTILITY Disturbance in spermatogenesis( production of sperm cell) Obstruction in somniferous tubules, duezor vessles preventing movement of spermatozoa. Qualitative and quantitative changes in seminal fluid preventing sperm motility. Development of autoimmunity that mobilize sperm. Problems in ejaculation or deposition preventing spermatozoa from being placed close enough to the women cervix to allow ready preparation and fertilization.

5. ETIOLOGY OF INFERTTILIY

6. MALE FACTORS 1. SPERM PRODUCTION PROBLEM Azoospermia Oligospermia Tetrazoospermia Asthenozoospermia Necrozoospermia Undescended testis Varicocele Infections

7. BLOCKAGE OF SPERM TRANSPORT Congenital absence of vas deference Vasectomy

8. SEXUAL PROBLEM Premature ejaculation Failure to ejaculation Erectile dysfunction Spinal cord injury . CHROSOMAL ABNRMALTIES Klinefelter syndrome Mixed gonadal dysgenesis  

9. SUBSTNCE ABUSE Alcohol smoking and caffeine – Excessive alcohol smoking and caffeine lowers the testosterone level and sperm quality in men. It can also reduce libido and cause impotence.

10. FEMALE FACTORS OVULATORY DYFUCTION Anovulation Oligo ovulation

11. DECREASED OVARIAN RESERVE The number of resting non growing primordial follicle refers to as the ovarian reserve. The main reason for decreasing ovarian reserve is - Advance maternal age Premature ovarian failure Resistant ovary syndrome  

12. TUBAL FACTORS Pelvic infections Tubal pregnancy Endometriosis CONGENITAL ABNORMALTIES Turner syndrome – Is monosomy of second sex chromosomes. It is a chromosomal condition that affects development in female. In turner syndrome loss of ovarian function and. It cause the infertility.

13. AQUIRED ABNORMALTIES Acquired abnormalities like endometrial polyp and intrauterine adhesion can must interfere the implantation and collection of dense fibrous in some case so ii affect the women infertile.

14. CERVICAL FACTORS PERITONEAL FACTORS Disease of peritoneal cavity may cause infertility, Infertility due to peritoneal polyp. Peritubal and periovarian adhesion and tubal abstructtion cause infertility. Kinking ( twisting) of fallopian tube. ANTISPERM ANTIBODIES

15. UNEXPLAINED FERTILITY Unexplained infertility accounts for 10% cases of infertility. A diagnosis of unexplained fertility made when all investigation are normal, but also present in infertility.

16. PATHOPHISIOLOGY MALE Due to blockage of sperm transport Inhibit the meeting of ovum and sperrm Absence of fertilization It causes infertility

17. FEMALE Due to ovulatory dysfunction Absence of release of ovum It inhibit the meeting the sperm and ovum because of anavulation Absence of fetilization It cause infertility

18. DIAGNOSTIC EVALUATION OF INFERTILITY HISTARY TAKING PHYSIICAL EXAMINATION SPERM ANALYSIS

19. Immuno beads are small beads that are treated with special proteins. If antibodies to sperm are present, these beads will attach to the sperm. One hundred motile (swimming) sperm are evaluated for bead attachment. For the male, if twenty or more of these sperm have beads attached to them (a result of 20% or greater), this is considered a positive test and indicates that antisperm antibodies may be present. For the female, a result greater than 10% is considered a positive test. ANTISPERM ANTIBODY TESTING

20. SPERM PENETRATION ASSAY Sperm penetration studies are laboratory test to determine whether sperm, once they reach the ova, can penetrate the ova. Using a artificial reproductive technique such as in vitro fertilization. The number of sperm that penetrate the egg is measured. Results are based on the number of sperm that can penetrate the egg Normal – sperm penetrate Abnormal - Sperm cant penetrate the egg.

21. SCROTAL ULTRASOUND HORMONE TESTING POST EJACULATION URINALYSIS GENETIC TESTING TRANSDUCTAL ULTRASOUND FERTILITY TESTING

22. FEMALE DETERMINATION OF OVULATION By basal body temperature Determination by cervical mucus assessment Determination by strip ASSESSMENT OF OVARIAN RESERVE ( AMH TESTING) ASSESSMENT OF THE FALLOPIAN TUBES AND UTERUS Hysterosalpingogram (HSG)

23. Genetic testing Laparoscopy Hysteroscopy

24. MANAGEMENT MALE PARTENR   Antisperm antibodies Retrograde ejaculation Lifestyle SURGICAL CARE Varicocelectomy Vasovasostomy or vasoepididymostomy Electroejaculation

25. Important Nutrients for Male Fertility Health Zinc Folic acid B12 Vitamin C Eat at least one large green salad per day 

26. FEMALE PARTNER   Correction of underlying problem Assisted Reproductive Technology or ART: Assisted reproductive technology (ART) is the technology used to achieve  pregnancy  in procedures such as  fertility medication ,  in vitro fertilization  and  surrogacy . It is  reproductive technology  used primarily for  infertility  treatments, and is also known as  fertility treatment.

27. TYPES GIFT IVF – ET IUI ZIFT ICSI

28. ARTIFICIAL INSEMINATION  ( AI ) INDICATION The women has a vaginal or cervical factor interfering with sperm motility. Man has a known genetic disorder and he dose not want to transmitted to offspring or the women has no male partner.

29. It is useful for the male for who underwent a vasectomy now wish to have children. Main types of artificial insemination intrauterine insemination (IUI) and intra cervical insemination (ICI),   PROCEDURE CONTRAINDICTION

30. IN VITROFERTILIZATION AND EMBRYO TRANSFER In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus.   INDICTION Damage follopian tube Decreased sperm count Genetic and ovulation disorder

31. PROCEDURE

32. GAMETE INTRA FALLOPIAN TUBE TRANSFER (GIFT) GIFT is an assisted reproductive procedure which involves removing a woman’s eggs, mixing them with sperm, and immediately placing them into a fallopian tube. PROCEDURE INDICATION ADVANTAGES AND DISADVANTAGES

33. ( ZIFT) ZYGOTE INTRAFOLLOPIAN TUBE TRANSFER

34. PROCEDURE A woman’s ovaries are stimulated with  medications  to increase the probability of producing multiple eggs. Eggs are then collected through an aspiration procedure. Those eggs are fertilized in a laboratory in a procedure identical to IVF, with the exception of the time frame. During the ZIFT procedure, fertilized eggs are transferred within 24 hours, versus 3-5 days as used in a regular IVF cycle. The fertilized eggs are then transferred through a laparoscopic procedure where a catheter is placed deep in the fallopian tube and the fertilized eggs injected. The final step is to watch for early  pregnancy symptoms . The fertility specialist will probably use a  blood test  to determine if pregnancy has occurred. 

35. INDICATINON Tubal blockage Significant tubal damage An anatomic problem with the uterus, such as severe intrauterine adhesions Sperm that is not able to penetrate an egg

36. ADVANTAGES DISADVANTAGES The main advantage is that the pregnancy rate increases, since the gametes are not inserted separately but only those which have been previously fertilised . Those who support or use this technique stress that this procedure is similar to natural fertilization, since the embryo spends a shorter period of time outside its natural environment and, thus, its quality improves. One of its main disadvantages is that ectopic pregnancy is more likely to happen. Moreover, an invasive surgery is required, which implies greater levels of difficulty and potential risks. It is also worth to mention that, since more than one zygote can be inserted, the rates of  multiple births ,  miscarriage , and other problems derived from pregnancy are higher if compared to other techniques.

37. INTRACYTOPLASMIC SPERM INJECTION One single spermatozoon or even a spermatid is injected directly into the cytoplasm of the oocyte by micro puncture of the zona pellucida . Micro pipette is used to hold the oocyte while spermatozoa is deposit inside the cytoplasm. INDICATION Azospermia Faliure to fertilization Unexplained fertility  

38. OTHER TECHNIQUE SURROGATE EMBRYO TRANSFER

39. ALTERNATIVES TO CHILDBIRTH   surrogate mother ADOPTION CHILDFREE LIVING

40. ADOPTION PROCEDURE   MEANING Adoption is the process through which a child becomes the lawful child of his adoptive parents. He will have all the rights, privileges and responsibility of a biological child.

41. Who can be adopted ? An orphan  An abandoned child   A surrendered child

42. WHO CAN ADOPT ? Any Indian, NRI or foreign citizen can adopt a child, though the procedure for all three is different. Any male or female irrespective of their marital status is eligible to adopt. A single female can adopt a child of any gender but a single male cannot adopt a girl child. If a couple is adopting, they should have two years of stable marriage and consent of both the spouses is necessary. Age difference should not be less than 25years between the adoptive parents and the adoptive child.

43. CONDITIONS TO BE FULFILLED The prospective parents should be emotionally, mentally and physically stable. They should be financially capable to raise a child. They should not have more than four kids. They should not be suffering from a life threatening disease

44. Procedure followed for adoption of a child Prospective parents register online or can reach District Child Protection Officer (DCPO) to register the prospective parents online. The application form is available at www.cara.nic.in . The adoption agency prepares a Home Study report describing the various factors and circumstances of the family within one month of the registration. The home study report shall be posted on the database by the adoption agency. The parents are given chance to choose their prospective child based on their preferences. They are shown photographs, child study reports and medical examination reports of up to six children.

45. The prospective adoptive parents may reserve one child within a period of forty eight hours for possible adoption and the rest of the children would be released for other prospective parents. The adoption agency will fix the meeting of the prospective adoptive parents to access whether they are suitable parents or not. The parents should also be allowed to have a meeting with the child. The entire process of matching should not take more than fifteen days. While accepting the child the prospective adoptive parents should sign the Child Study Report in presence of social worker. If prospective parent do not accept the child or the child do not accept the parent then same procedure will be followed for other chances.

46. LEGAL AND ETHICAL ISSUES THAT ARE REGULATED INCLUDE   The use of   donor sperm and eggs : for example, anonymity is guaranteed in law for donors in Greece, but no longer allowed in the UK. The use and payment of   surrogates : for example, commercial surrogacy is banned in many countries but is completely legal in India.   The in vitro development period allowed for embryos:  for example, in many countries, embryos are allowed to develop for several days to allow selection of the healthiest candidates but in others only early embryos can be implanted.  

47. The selection process for embryos, including sex selection and  genetic screening :  for example, pre-implantation genetic diagnosis ( PGD ) is banned in some countries but allowed under strict regulations in others. The maximum number of embryos that can be transferred:  for example, many countries have strict single embryo transfer policies , while others will leave the number of embryos implanted up to the discretion of the fertility specialist. The maximum storage time for frozen embryos: for example, Spain and Canada allow unlimited storage, whereas Brazil has a limit of just three years.