Infertility 1.pptx Shweta singh M.sc nursing

Infertility
Presented by –
Ms. Shweta Singh

INTRODUCTION
 Infertility is a disease of the male or female reproductive system
defined by the failure to achieve a pregnancy after 12 months or
more of regular unprotected sexual intercourse.
 Infertility affects millions of people of reproductive age
worldwide – and has an impact on their families and
communities. Estimates suggest that between 48 million
couples and 186 million individuals live with infertility globally.

 In the male reproductive system, infertility is most commonly
caused by problems in the ejection of semen, absence or low levels
of sperm, or abnormal shape (morphology) and movement
(motility) of the sperm.
 In the female reproductive system, infertility may be caused by
a range of abnormalities of the ovaries, uterus, fallopian tubes, and
the endocrine system, among others.

Definition –
o Infertility is defined as a failure to achieve a clinical
pregnancy after 12 months or more of regular
unprotected sexual intercourse.
(By WHO)

Primary infertility denoted those patients who have never
conceived.
secondary infertility indicates previous pregnancy but failure to
conceive subsequently.
Incidence –
Generally, worldwide it is estimated that one in seven couples
have problems in conceiving.
Infertility affects up to 15% of reproductive-aged couples
worldwide.
In India most of these cases women is the factor.

Fertility problems affect one in seven couples in United Kingdom.
According to World Health Organization estimate the overall
prevalence of Indian states prevalence of infertility varies from state
to state such as 3.7 per cent in Uttar Pradesh, Himachal Pradesh and
Maharashtra, to 5 per cent in Andhra Pradesh, and 15 per cent in
Kashmir and prevalence varies in same region primary infertility in
India is between 3.9 to 16.8%. In across tribes and caste.

Primary And Secondary Infertility: Causes of
Infertility
There are two kinds of infertility - primary and secondary:
 Primary – this type of infertility is when a couple has never
been able to conceive.
 Secondary – The couple is presently having difficulties to
conceive but has children.

Primary infertility
A couple with primary infertility has never been able to conceive a
child.
it is necessary that the couple has been having unprotected
intercourse for at least 12 months without luck.
The first approach typically includes a semen analysis for the man.
As for the woman, both an ultrasound scan and bloodwork are
required
In case the cause of infertility is undetectable with these basic tests,
other diagnostic tests will be run.

The following are the most common ones:
1.Hormonal imbalances
hypogonadism, hypothyroidism etc.
2.Poor sperm quality
oligospermia, asthenospermia, teratozoospermia, etc.
3.Ovary problems
anovulation, Polycystic Ovary Syndrome (PCOS), early menopause, etc.
4.Tubal factor
salpingitis, endometriosis, hydrosalpinx, etc.

5.Uterine factor
uterine abnormalities, myomatosis, cervix disorders, etc.
6.Genetic causes
Turner syndrome, Klinefelter syndrome, etc.
7.Others
8.Sexually Transmitted Diseases (STDs), immune infertility,
etc.

In Men
Causes of primary infertility in men can be due to the following
reasons
 Low sperm count.
 Sperm mobility issues.
 Abnormal functioning of the sperm.
 Excessive alcohol consumption.
 Chain smoking.
 Age
 Infection in the testicles.

In Women
Causes of primary infertility in female can be due to the following
reasons
 Lack of ovulation or difficulty in ovulation
 Hormonal imbalance
 Cysts in the ovaries or PCOS
 Excessive alcohol consumption
 Unable to produce a mature egg
 Age
 When a mature egg fails to get attached to the lining of the
uterus.

Secondary infertility
Secondary infertility occurs when a couple were able to
conceive and give birth to a child in the past, but they are
unable to conceive when attempting to have another baby.
Also, if one member of the couple is infertile but had children
with another person previously, we speak of secondary
infertility as well.

Causes of secondary infertility in women include:
 Problems in the quantity or quality of eggs: Women are born
with a limited supply of eggs and are unable to create new eggs after
birth. As women approach their 40s and beyond, the numbers of eggs
left in their ovaries decrease, and the remaining eggs have a higher
chance of having chromosomal problems. For women where age isn’t
a concern, there are other reasons that they might have a low number
of good quality eggs, including autoimmune or genetic conditions and
prior surgery or radiation.

 Problems with the fallopian tubes: The fallopian tubes, which
carry eggs from the ovaries to the uterus, can become blocked due to
pelvic infections such as chlamydia or gonorrhoea.
 Endometriosis: Endometriosis is a condition where tissue that
normally grows inside the uterus grows elsewhere in the body, such
as on the ovaries or bowel surfaces. While endometriosis is
common, not all endometriosis causes infertility.

 Problems with the uterus: There are many conditions related
to the uterus that can cause secondary infertility. Scarring can
occur during a dilation and curettage (D&C) or
Caesarean delivery that can create adhesions inside the uterus
that interfere with future pregnancies. Fibroids or polyps are
benign (non-cancer) growths inside the uterus that can impair
pregnancy. A retained placenta can cause infection and uterine
scarring.

 Polycystic ovary syndrome: This is a hormonal disorder
characterized by longer-than-normal or infrequent menstrual
periods. A woman with this condition has an excessive number of
male hormones, and the ovaries fail to release eggs regularly.
 Breastfeeding: If a woman feeds her baby only by breastfeeding, her
body stops ovulating or releasing eggs for potential fertilization.

 Weight gain or other lifestyle changes: Weight gain can lead
to ovary dysfunction in some patients. Certain diets may affect
fertility.
 Medications may also affect fertility.

Causes of secondary infertility in men include:
 Reduced testosterone level
 Testosterone plays a key role in sperm production. Testosterone
levels can decline due to aging, injury to urinary or genital organs,
or certain medical conditions.
 Certain drugs affect sperm count and quality

 These drugs include some antibiotics and medication that treat
high blood pressure. Sperm quality can also be affected by
treatments for the following conditions:
 If a man and woman 35 or younger have had unprotected sex for
at least 12 months (or six months if older than 35) without
getting pregnant, they should suspect secondary infertility. This
especially applies to women older than 30 who have
experienced pelvic inflammatory disease, painful periods,
irregular menstrual cycles or miscarriages, and to men with low
sperm counts.

Difference Between Primary Infertility and Secondary
Infertility
The treatments and causes may sound similar for primary and
secondary, but the emotions and circumstances experienced to
make a major difference.
# Primary infertility is due to the inability to conceive even once
after trying for a year without preventive measures. In
comparison, secondary infertility is when couples have a child
before but now can’t conceive.

#.Primary infertility is best treated with IVF, while secondary
infertility can also be caused by stress which can be treated through
therapies.
# Primary Infertility has a low success rate, while secondary infertility
has a high success rate.
# The leading cause of primary cases can be sperm quantity and
quality or reproductive abnormalities or damage. Infertility may occur
due to age factors;
lifestyle aspects include smoking, weight gain, or weight loss

DIANOSTIC PROCEDURE -
Both male and female factors can contribute to infertility. A detailed
medical history, physical examination and investigations are needed
to assess the cause of infertility.
Evaluation of infertility includes following steps:
(a) History taking: Couples with infertility problem are
interviewed separately as well as together to know about important
facts with full history taking. Full history includes: present history;
menstrual and obstetric history (in female partner); contraceptive
and sexual history; family and past history.

(b)Clinical examination: Full clinical examination of both
partners is required for detection of any physical problem. It
includes general examination along with examination of chest,
breast, abdomen, and genitalia. It helps to health care professional
to make a provisional diagnosis. Investigations are advised to prove
the clinical diagnosis and to exclude other close possible causes.

(c) Investigations: Infertile couples are usually advised to start
their investigations after 12 months of trying to conceive or after six
months if the female partner is more than 35 years old or
immediately if there is an obvious cause for their infertility or
subfertility.
As the major causes of infertility are sperm abnormalities, ovulation
dysfunction, and fallopian tube obstruction, the preliminary
investigations for the infertile couple should be focused on:-

Semen analysis: It should be done after 72 hours of sexual
abstinence and two analysis should be advised with 3 months apart
at the same lab. (Results may be interpreted for its volume, sperm
count, motility, and morphology according to the WHO reference
values).
Female partner
Detection of ovarian function:
Hormonal assay (early follicular FSH and LH levels, and mid-luteal
progesterone levels),Transvaginal ultrasonography is used for
detection of ovulation in females and any abnormality in uterus and
adnexa (adjoining anatomical parts of the uterus).

Evaluation of tubal patency:
Hysterosalpingography (HSG): It is a radiological procedure.
The dye is injected in to the uterus through the cervix and
simultaneously X-Ray pictures are taken to see the movement of
dye in to the fallopian tubes. Spilling of dye into the abdominal
cavity shows that tubes are patent.

Advanced investigations-
Hormonal assay: Thyroid function test, prolactin levels,
testosterone, and other tests if polycystic ovary syndrome is
suspected.
Laparoscopy is a surgical procedure used to visualize abdominal and
pelvic organs (uterus, fallopian tubes and ovaries).
Hysteroscopy is indicated for intrauterine space-occupying lesions
detected on HSG
Chromosomal karyotyping is used for suspected genetic disorders.

Male partner-
Hormonal assay: FSH, LH, Testosterone, TSH and Prolactin (for
male with abnormal seminal analysis and suspected endocrine
disorder)
Testicular biopsy: A fine-needle aspiration biopsy to differentiate
between obstructive and non-obstructive azoospermia.
Chromosomal karyotyping is used for suspected genetic
disorders.

Infertility 1.pptx Shweta singh M.sc nursing

Infertility 1.pptx Shweta singh M.sc nursing

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