management of client with fertility problems

the presentation gives the outline on the management of client with fertility problems

1. IDA KHOMBE
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2. Define the term:
Infertility
Describe the classification of infertility
Describe the pathophysiology for infertility
Explain risk factors for female/male infertility
Describe the Diagnosis for Infertility
Explain the management of infertility

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3. For conception to take place, the following conditions
have to be favourable:
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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4. Is the inability of a woman to
conceive or a man to bring about
conception after at least a year of
regular sexual intercourse without
contraception, with the same
partner.
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6. Primary infertility
This is when the couple has never conceived.
 inability to conceive in a couple that has
had no previous pregnancies.
Secondary infertility
Inability of a couple to conceive after it has
had at least a previous pregnancy which
ended in a live birth, still birth,
miscarriages, ectopic pregnancy or induced
abortion.
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7. Normal fertility is dependent on many
factors:
 Endocrine, ovarian, cervical in females
Endocrine, testicular, channels in males
Any deviation from the above, results in
infertility.
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8. Age
Stress
Poor diet
Smoking
Alcohol
STIs
Overweight
Underweight
Caffeine intake
Too much exercise
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9. A woman's fertility
naturally starts to decline
in her late 20's.
After age 35 a woman's
fertility decreases rapidly.
A woman is born with all
the eggs she'll have, and
with time, the supply
diminishes.
The remaining eggs also
age along with the rest of
the body.
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10. Severe endometriosis
Pelvic Inflammatory Disease (PID)
Ovulation disorders
Elevated prolactin
Polycystic ovary syndrome (PCOS)
Early menopause
Benign uterine fibroids
Pelvic adhesion
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11. Endometriosis
Pelvic Inflammatory Disease
Uterine Fibroids
Pelvic Adhesions
Ovarian Failure
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12. Occurs when the uterine tissue implants and
grows outside of the uterus, affecting the
function of the ovaries, uterus and fallopian
tubes.
Scar tissue can block the fallopian tubes and
prevent the egg from entering the uterus.
There is a 25-35% rate of infertility in
moderate to severe cases of Endometriosis
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13. Occurs when the uterine
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14. Pelvic inflammatory disease (PID) is a spectrum of
infections of the female genital tract that includes
endometritis, salpingitis, tuboovarian abscess, and
peritonitis.
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15. Fibroids are benign tumors in the wall of the
uterus
May cause infertility by blocking the fallopian
tubes
Pelvic adhesions are bands of scar tissue that
bind organs after pelvic infection, appendicitis,
or abdominal or pelvic surgery
This scar tissue formation may impair fertility.
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16. Fibroids
Pelvic adhesions
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17. Ovarian failure can be a consequence of medical
treatments, or the complete failure of the ovaries
to develop or contain eggs in the first place
(Turner's Syndrome).
Ovarian failure can also occur as a result of
treatments such as chemotherapy and pelvic
radiotherapy for cancers in other body areas.
These therapies destroy eggs in the ovary.
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18. Ovulation disorders
Elevated prolactin
Polycystic ovary syndrome
Early menopause
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19. Disruption in the part of the brain that regulates
ovulation can cause low levels of luteinizing
hormone (LH) and follicle-stimulating
hormone (FSH).
Even slight irregularities in the hormone
system can affect ovulation.
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20. Also called Hyperprolactinemia
Can cause irregular or no ovulation
Irregular periods
May cause galactorrehea, milk production
when not pregnant
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21. Sep 24, 2024infertility 21
Polycystic ovary
syndrome (PCOS)
Produces too much
androgen hormone
(male hormones)
Causes an irregular
or no menstrual
cycle

22. Absence of menstruation
Early depletion of ovarian follicles before age 35
Although the cause is unknown, certain conditions
are associated with early menopause, including
immune system diseases, radiation or
chemotherapy treatment, and smoking
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23. Medications
Thyroid problems
Cancer and treatment
Other medical conditions
conditions associated with delayed puberty or
amenorrhea, sickle cell disease, HIV/AIDS,
kidney disease and diabetes
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24. Anti-sperm antibodies (ASA)
Oocyte membrane proteins
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25. The developing embryo may be miscarried due
to the mother’s immune system recognizing it
as a “foreign body” and attacking it.
Also, the woman may produce anti-sperm
antibodies (ASA) to her partner’s sperm.
ASA neutralize sperm by clumping them
together and destroying their membranes.
They also coat over receptors involved in
sperm-egg binding and fertilization.
An estimated 12 to 15 percent of unexplained
infertility in women is linked to ASA.
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26. Receptin, an Oocyte membrane protein, is
responsible for binding sperm with the egg.
If this protein is not receptive or present,
fertilization cannot occur.
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27. Hard Eggs
Teratogens
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28. If the egg is too 'hard', then the embryo cannot
hatch out of the zona pellucida and it dies.
To fix this problem, scientists can make a tiny
hole in the egg to give it a head start.
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30. Damage from external sources, including
viral infections, x-rays and other radiation,
and poor nutrition
Depending on the stage of development at
which the exposure to the teratogen takes
place, a variation of developmental
malformations may occur.
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31. PRETESTICULAR
TESTICULAR
POST TESTICULAR
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32. ENDOCRINE
1.Hypogonadotropic hypogonadism
2.Hyperprolactinemia
3.DM
4.Hypothyroidism
5.Steroid abuse
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33. 1.Erectile dysfunction
2. Ejaculatory failure
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34. Anything that interferes with the nerve pathway
can cause erectile dysfunction
Trauma such as head and spinal cord injuries,
stroke, Parkinson's disease, and diseases with
systemic effects such as multiple sclerosis and
diabetes can diminish nerve function and lead
to impotence.
Aging
medications and alcoholism can also cause
impotence
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35. Ejaculatory failure can be grouped under 4
categories –
a.unejaculation – no ejaculation of sperms.
b. Retrograde ejaculation – semen is ejaculated
in bladder.
c. Premature ejaculation – inability to control
ejaculation for sufficient length of time
during intravaginal containment to satisfy
female partner
d. Ejaculatory obstruction – failure to achieve
erection.
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36. GENETIC
Klienfelter syndrome,
Y chromosome deletion,
Immotile cilia syndrome
CONGENITAL
Cryptorchidism
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37. ORCHITIS
1.Infective
2.Traumatic
VASCULAR
1.Torsion
2.Varicocele
IDIOPATHIC
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38. OBSTRUCTIVE
1.Epididymal
2.Vasal
ACCESSORY GLAND INFECTION
1.Prostitis
2.Seminal vesiculitis
IMMUNOLOGIC
1.Post vasectomy
2.idiopathic
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39. 1.Chest radiography -to r/o TB.
2.Urine and stool microscopy- to r/o
Schistosoma and other parasites.
3.Blood:
FBC - to ascertain if ED is due to anaemia
FSH, LH, Testesterone
4. Hysterosalpingogram
5. Biopsy- endometrial
6. Cervical mucus and semen analysis
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40. SEMEN ANALYSIS
Obtained by masturbation
Provides immediate information
Quantity
Quality
Density of the sperm
Morphology
Motility
Instruct the couple to abstain from coitus 2
to 3 days

41. SEMEN ANALYSIS
Collect all ejaculate and analyze within 1 hr
A normal semen analysis has normal motility,
sperm count
Repeat analysis after 30 days

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43. Identify and treat the cause
Medical management
Surgical management
Psychosocial management
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44. Gonadotropin Releasing Hormone (GnRH)- for
those with hypogonadotropic hypogonadism
Clomiphene citrate (Clomid)
50mg from day 2 of menses
100mg dy 2 of menses
150mg dy 2 of menses
For at-least 6 cycles
Metformin 500mg 8 hourly for a week to
enhance effectiveness of Clomiphene
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45. Steroids- to those with ASA- 3 to 6 months
Imipramine
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46. Varicocelectomy
Vasovasostomy or vasoepididymostomy
Transurethral resection of the ejaculatory
ducts
Electro-ejaculation
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47. Artificial insemination
In vitro fertilization
Gamete intra-fallopian transfer (GIFT) and
zygote intra-fallopian transfer (ZIFT)
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48. Artificial Insemination

50. Counsel on avoiding activities that interfere with
sexual activity and fertility; and to limit
environmental exposures to harmful substances
and/or conditions.
Vigorous exercises
Smoking cigarettes
Marijuana
Stress-relief therapy and consultations.
Extreme diets - Anorexia nervosa
Appropriate diet
Dietary supplements and vitamins
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51. Counsel on good sexual activity
At least 3-4 times per week
Sex positions
No use of herbs in the vagina
Counsel on treatment compliance
Counsel HIV positive couples accordingly
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