2. INFERTILITY
Definition
Primary infertility: a woman who has failed to
conceive for at least two years despite being
exposed to the possibility of pregnancy(having
unprotected sex with a fertile man.
• The couple has never conceived at any point.
3. • Subfertility: is used to describe a couple having difficulty in
conceiving because both partiners have reduced fertility.
• Secondary infertility: is applied to couples who have been
unable to conceive after one or more successful
pregnancies.
4. • Failure of pregnancy: the woman can conceive but cannot
carry the pregnancy to term.
5. Causes of male infertility
Impaired production or function of sperm
• Impaired shape or movement of sperm
• Low sperm concentration
• Varicocele
• Undescended testicle
• Testosterone deficiency (male hypogonadism)
• Genetic defects
• Infections
6.
7. Causes of male infertility
Impaired delivery of sperm
• Sexual issues
• Retrograde ejaculation
• Blockage of epididymis or ejaculatory ducts
• No semen (ejaculate)
• Hypospadias
• Anti – sperm antibodies
• Cystic fibrosis
8.
9. Causes of male infertility
General health and lifestyle
• Emotional stress
• Malnutrition
• Obesity
• Cancer and its treatment
• Alcohol and drugs
• Age
• Other medical conditions
10. Causes of male infertility
Environmental exposure
• Pesticides and other chemicals
• Overheating the testicles
• Substance abuse
• Tobacco smoking
18. Risk factors
• Age
• Tobacco smoking
• Alcohol use
• Being overweight
• Caffeine intake
19. Tests and diagnosis
Tests for men
• General physical
examination
• Semen analysis
• Hormone testing
• Transrectal and scrotal
ultrasound
Tests for women
• Ovulation testing
• Hysterosalpingography
• Laparoscopy
• Hormone testing
• Ovarian reserve testing
• Genetic testing
• Pelvic ultrasound
20. MANAGEMENT OF INFERTILITY
• Initial management of infertile couples is through
• primary care-preliminary investigation of both partners and
subsequent referral is done.
• The investigative process is aimed at achieving an accurate
diagnosis and definition of any cause,
• an accurate estimation of the chance of conceiving without
treatment and full appraisal of treatment option
21. Cont…
• Both partners should be involved in the management of their
infertility.
• Full explanation should be given at each stage of the
investigation.
• Detailed history of drug usage.
• The female partiner should be investgated for progestrone
levels while the male partiner should have initial two semen
analysis done
23. Assessment
• . The partners must be received together,
• then separately, in a quiet and relaxed atmosphere.
• A detailed history must be taken from both partners, with
special attention to past and present symptoms that may
point to any of the etiologies discussed above
24. Assessment
• The provider should allow enough time to discuss and give
explanations.
• Ask about duration of cohabitation;
Duration of marriage
How long the couple has tried to have a child
Number of times there is sexual intercourse in a week
Number of wife in case of polygamous marriage,
25. Assessment
Age of the last child
Couple’s knowledge of the menstrual cycle
Age of puberty
• Identify the type of infertility (primary or secondary)
• Get information about the following:
• Factors that may influence infertility: eg.
Frequent sexual intercourse
Absence of a partner from home
26. Assessment
• Sexual dysfunction (dyspareunia, vaginismus, impotence, premature
ejaculation, absence of ejaculation) .
• The menstrual cycle (including premenstrual syndrome, signs of
ovulation)
• Medical, surgical ,obstetrical, and gynecological history (STIs, earlier
use of contraception, history of hernias, abortion, premature labor,
post-abortion infections).
27. Assessment
• Each partner should be examined seperately to allow for
discovery of antecedents or history that may be unknown to
the other partner, such as STIs.
• The provider should conduct a complete physical
examination of both the internal and external and genital
organs, followed by a simple explanation of the physiology
of reproduction and factors that might affect fertility.
28. Assessment
• Examinations (Paraclinical or lab) must be explained and
discussed).
• The provider should also comfort the couple by explaining
that feelings of failure, guilt, or blame are common, and
explaining that infertility is a problem of couples, not an
individual problem.
31. 3. Invitro fertilization
Used in cases where
fertility has resulted from tubal factors,
mucus abnormalities,
male infertility,
unexplained infertility,
male and female immunologic infertility,
and cervical factors
32. Cont…
The woman eggs are collected from the ovaries,
fertized in the labolatory,
and placed into her uterus after normal embryo development
has begun
33. Other assisted reproductive techniques
• Gamete intrafallopian transfer
• Embryo cryopreservation
• In vitro fertilization using donor Oocytes
34. Cont…
• Embryo donation
• Micromanipulation and blastomere analysis
• - it allows individual eggs and sperm to be hundled through
the use of very fine, specialized instrument
- It allows the clinician to inject the sperm cell directly into an
egg
