Lect 34 Unit IV Infertility.ppt ahn 1..

Infertility ahn 1

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Sub: AHN-I
Unit: IV Reproductive Disorders
Topic:Topic: Infertility
Lect:Lect: 34
By By
Asif Ali Magsi Asif Ali Magsi

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3. Definitions & Terminology
•Fertility: the capacity to reproduce or the state
of being fertile.
•Fecundability: the probability of achieving a
pregnancy each month.
•Fecundity: the ability to achieve a live birth
within 1 menstrual cycle.
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4. Requirements for Conception
•Production of healthy egg and sperm
•Unblocked tubes that allow sperm to reach the
egg.
•The sperms ability to penetrate and fertilize the
egg.
•Implantation of the embryo into the uterus
•Finally a healthy pregnancy
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5. Definitions
•Infertility: A woman under 35 has not conceived
after 12 months of contraceptive-free intercourse.
•Twelve months is the lower
 reference
limit
 for 
Time to Pregnancy 
(TTP) by the World
Health Organization.
•A woman over 35 has not conceived after 6
months of contraceptive-free
 sexual intercourse.
•Men and women equally affected
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6. Types of Infertility
•Primary Infertility
–A couple that has never conceived despite of
unprotected sex for 12 months
•Secondary Infertility
– Infertility that occurs after previous pregnancy
regardless of outcome
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7. Causes of infertility in Female
•Eating disorders Eating disorders
•Ovulation problems
•Premature ovarian
failure
 
•Tubal blockage
•Uterine problems
•Endometriosis
•Surgery
 
•Previous sterilization treatment
 
Previous sterilization treatment
 
•Previous tubal ligationPrevious tubal ligation
•Over-exercising Over-exercising (may cause (may cause
ovulation problems)ovulation problems)
•PCOS (polycystic ovary syndrome)
•Submucosal fibroids
•Past infections
•Structural Problem
•Poor sperm motility and/or count
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8. Causes of infertility in Male
•AgeAge
•SemenSemen
•Low sperm countLow sperm count
•No sperm
 
No sperm
 
•Low sperm mobility
 
Low sperm mobility
 
•Abnormal spermAbnormal sperm
•Testicular infectionTesticular infection
•Testicular cancerTesticular cancer
•Testicular surgeryTesticular surgery
•Overheating the testiclesOverheating the testicles
•Ejaculation disorders
 
Ejaculation disorders
 
•VaricoceleVaricocele ((varicose vein in varicose vein in
the scrotum )the scrotum )
•Undescended testicle
 
Undescended testicle
 
•Hypogonadism Hypogonadism ((testosterone testosterone
deficiency can result in a deficiency can result in a
disorder of the testicles disorder of the testicles  
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9. Causes Of Infertility In Either Sex
•Age: Age: (a woman's fertility starts to drop after she is about 32 (a woman's fertility starts to drop after she is about 32
years old, and continues doing so. A 50-year-old man is years old, and continues doing so. A 50-year-old man is
usually less fertile than a man in his 20s (male fertility usually less fertile than a man in his 20s (male fertility
progressively drops after the age of 40)progressively drops after the age of 40)
•Smoking:Smoking:  (smoking significantly increases the risk of (smoking significantly increases the risk of
infertility in both men and womeninfertility in both men and women
•Alcohol consumption: Alcohol consumption: ((a woman's pregnancy can be a woman's pregnancy can be
seriously affected alcohol consumption. Alcohol abuse may seriously affected alcohol consumption. Alcohol abuse may
lower male fertility.lower male fertility.
•Not exercising:Not exercising:  (leading a sedentary lifestyle is sometimes (leading a sedentary lifestyle is sometimes
linked to lower fertility in both men and women.linked to lower fertility in both men and women.
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10. Cont…
•Being obese or overweight:Being obese or overweight:  (overweight/obesity and a (overweight/obesity and a
sedentary lifestyle are often found to be the principal sedentary lifestyle are often found to be the principal
causes of female infertility and higher risk for man causes of female infertility and higher risk for man
having abnormal sperm.having abnormal sperm.
•Sexually transmitted infections:Sexually transmitted infections: (Chlamydia can (Chlamydia can
damage the fallopian tubes, as well as making the man's damage the fallopian tubes, as well as making the man's
scrotum become inflamed)scrotum become inflamed)
•Exposure to some chemicals: Exposure to some chemicals: ((some pesticides, some pesticides,
herbicides, metals (lead) and solvents have been linked herbicides, metals (lead) and solvents have been linked
to fertility problems in both men and women)
 
to fertility problems in both men and women)
 

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11. Cont…
•Stress:Stress: (female ovulation and sperm production (female ovulation and sperm production
may be affected by mental stress) may be affected by mental stress)
•General factors:General factors: ((Diabetes mellitus,
 thyroid
Diabetes mellitus,
 thyroid
disorders,
 adrenal disease)
disorders,
 adrenal disease)
•MedicationsMedications (e.g. NSAIDs,(e.g. NSAIDs, Chemotherapy, Chemotherapy,
Illegal drugs (cocaine)Illegal drugs (cocaine)
•RadiotherapyRadiotherapy
•Genetic factorsGenetic factors
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12. Sign & Symptoms
•Inability to achieve conception.
Diagnostic Tests for Males
•General physical exam
 
•Semen analysis
 
•Blood test
 (including the man's level of testosterone
and other male hormones)
•Ultrasound test
 
•Chlamydia test
 
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13. Diagnostic Tests for Females
•General physical exam
•Blood test
 (hormone
levels)
•Hysterosalpingography
•Laparoscopy
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•Ovarian reserve testing
•Genetic testing
 
•Pelvic ultrasound
 
•Chlamydia test
 
•Thyroid function test
 

14. Treatment of InfertilityTreatment of Infertility
•Treatment of infertility depends on the cause,
diagnosis, duration of infertility, age of the
partners and many personal preferences.
•Some causes of infertility cannot be corrected.
•A woman can still become pregnant with assisted
reproductive technology or other procedures to
restore fertility
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15. ContCont……
•Artificial Insemination: Artificial Insemination: deposing semen into he deposing semen into he
female genital tract by artificial means is called female genital tract by artificial means is called
artificial insemination. artificial insemination.
•Insemination with donor:Insemination with donor: when the sperm of the when the sperm of the
women’s partner is defective or absent or when women’s partner is defective or absent or when
there is a risk of transmitting a genetic disease, there is a risk of transmitting a genetic disease,
donor sperm may be used. donor sperm may be used.
•In Vitro Fertilization: In Vitro Fertilization: In vitro fertilization In vitro fertilization
involves ovarian stimulation, age retrieval, involves ovarian stimulation, age retrieval,
fertilization, and embryo transferfertilization, and embryo transfer..
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16. Treatment for Men
•General sexual problems: General sexual problems: Addressing impotence Addressing impotence
or premature ejaculation can improve fertility. or premature ejaculation can improve fertility.
•Treatment for these problems often is with Treatment for these problems often is with
medication or behavioral approaches.medication or behavioral approaches.
•Lack of sperm:Lack of sperm: surgery or hormones to correct surgery or hormones to correct
the problem or use of assisted reproductive the problem or use of assisted reproductive
technology is sometimes possible.technology is sometimes possible.
•Varicocele:Varicocele: can often be surgically corrected.can often be surgically corrected.
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17. Treatment for Women
•Stimulating ovulation with fertility drugs:
•Fertility drugs are the main treatment for women
who are infertile due to ovulation disorders.
•These medications regulate or induce ovulation, and
work like natural hormones to trigger ovulation
such as: Follicle-stimulating hormone (FSH) and
Luteinizing hormone (LH).
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18. Fertility Drugs &The Risk of Multiple
Pregnancies
•Injectable fertility drugs increase the chance of
multiple births.
•Oral fertility drugs (Clomid) increase the chance of
multiple births but at a much lower rate.
•The use of these drugs requires careful monitoring.
•The greater the number of fetuses, the higher the risk
of premature labor.
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19. •Babies born prematurely are at increased risk of
health and developmental problems.
•These risks are greater for triplets than for twins or
single pregnancies.
•The greater the number of fetuses, the higher the risk
of premature labor.
Cont…..
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20. Surgery
•Depending on the cause, surgery may be a treatment
option for infertility.
•Blockages or other problems in the fallopian tubes
can often be surgically repaired.
•Laparoscopic techniques allow delicate operations on
the fallopian tubes.
•Infertility due to endometriosis often is difficult to
treat.
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21. Complications Of Infertility Treatment
•Ovarian hyperstimulation syndrome
 (OHSS)
Ovarian hyperstimulation syndrome
 (OHSS)
 (The (The
ovaries produce too many folliclesovaries produce too many follicles
•Ectopic pregnancyEctopic pregnancy
•Coping mentally Coping mentally ((As it is impossible to know how As it is impossible to know how
long treatment will go on for and how successful it will long treatment will go on for and how successful it will
be, coping and persevering can be stressful) be, coping and persevering can be stressful)
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22. Prevention
Some strategies suggested or proposed for avoiding
male infertility include the following:
•Avoiding
 smoking as it damages sperm DNA
•Avoiding heavy
 marijuna and alcohol use.
•Avoiding excessive heat to the testes.
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23. Nursing Management
•Assist in reducing stress in the relationship.
•Encourage cooperation
•Protect privacy
•Foster understanding
•Refer the couple to appropriate resources.
•Smoking is strongly discouraged
•Provide health education on diet, exercise ,stress
reduction techniques, health maintainance and
disease prevention (Smeletzer & Bera, 2004)(Smeletzer & Bera, 2004)
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24. References
•Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever. K. H. Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever. K. H.
(2011). (2011). Textbook of Medical – Surgical Nursing. Vol -I Textbook of Medical – Surgical Nursing. Vol -I
(12(12
thth
Ed.). Wolters Kluwer. New Delhi. Ed.). Wolters Kluwer. New Delhi.
•DiGiulio. M., Jackson. D. & Keogh.J. (2007). Medical-
Surgical Nursing Demystified- A self Teaching Guide.
McGraw-Hill. Toronto.
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25. Thank You!
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