Infertility (OBG, MSC NURSING PREVIOUS)

1. Divyesh

2. Divyesh

3.  Infertility is “a disease of the reproductive system
defined by the failure to achieve a clinical
pregnancy after 12 months or more of regular
unprotected sexual intercourse”.(WHO- ICMART)
 “Infertility is the inability of a sexual active, non-
contracepting couple to achieve pregnancy in one
year. (Semen manual, 5th edition)
 Infertility is defined as not being able to get
pregnant (conceive) after one year(or longer) of
unprotected sex.(CDC)
Divyesh

4. Divyesh

5. Divyesh

6.  Primary infertility- 3.9 – 16.8%
 3.7%- Uttar pradesh, himachal pradesh &
Maharashtra
 5% - Andhara pradesh
 15% - Kashmir
 1 out of 6 couples are affected by infertility in
urban areas
Divyesh

7. Primary infertility:- those who have never
conceived
Secondary infertility:- previous pregnancy but
failure to conceive
subsequently
Divyesh

8. Divyesh

9. Male infertility
 Defective spermatogenesis
 Obstruction of the efferent duct system
 Failure to deposit sperm high in the vagina
 Errors in the seminal fluid.
Divyesh

10. Defective Spermatogenesis:-
 Congenital
 Thermal factor
 Infection
 General factors
 Endocrine
 Genetic
 Iatrogenic
 Immunological factor
Divyesh

11. Obstruction of the efferent ducts:
 Infection like tubercular, gonococcal
 surgical trauma (herniorrhaphy) following
vasectomy.
 Young’s syndrome.
Failure to Deposit Sperm High in the vagina
(Coital problems):-
 Erectile dysfunction
 Ejaculatory defect
 Hypospadias
 Sperm abnormality
Divyesh

12. Errors in the seminal fluid:-
 Unusually high or low volume of ejaculate
 Low fructose content
 High prostaglandin content
 Undue viscosity
Divyesh

13. Divyesh

14. Female infertility
 Ovulatory factors
 Tubal and peritoneal factors
 Uterine factors
 Cervical factors
 Vaginal factors
 Unexplained
Divyesh

15. Ovulatory factors
 Anovulation or oligo-ovulation
 Decreased ovarian reserve
 Luteal phase defect
 Lutenised unruptured follicle
Divyesh

16.  Pelvic infections causing
Peritubal adhesions
Endosalpingeal damage
 Previous tubal surgery or sterilization
 Salpingitis isthmica nodosa
 Tubal endometriosis and others.
 Polyps or mucous debris within the tubal
lumen, or tubal spasm
Divyesh

17.  Peritoneal factors
 Uterine factors.
 Cervical factors
 Vaginal factors
Divyesh

18.  General factors
 Infrequent intercourse, lack of knowledge of
coital technique and timing of coitus
 Lifestyle, tobacco, smoking, alcohol
 Apareunia and dyspareunia.
 Anxiety and apprehension.
 Use of lubricants during intercourse,
 Immunological factors.
Divyesh

19. Male
 History
 Examination
 Investigations
 Routine investigations
 Semen analysis
 Serum FSH, LH, testosterone, prolactin, and
TSH
 Testicular biopsy
 Transrectal ultrasound (TRU S)
 Vasogram
 Karyotype analysis
 Immunological tests
Divyesh

20.  History
 Examinations
OVULATION
 BB T
 Cervical mucus study
 Vaginal cytology
 Hormone estimation:- S. progesterone,S. LH, s.
estradiol, Urine LH
 Endometrial biopsy
 Sonography (TVS)
 Laparoscopy
Divyesh

21. TUBAL FACTORS
 Insufflation test (Rubin’s test)
 Hysterosalpingography (HSG)
 Laproscopy
 Sonohysterosalpingography
UTERINE FACTORS
 Ultrasonography,
 HSG,
 hysteroscopy, and
 laparoscopy
CERVICAL FACTORS
 Postcoital test (PCT) (Sims-Huhner test)
 Sperm cervical mucus contact test (SCMCT)
Divyesh

22. Divyesh

23. MALE INFERTILITY
 General care
 Drug therapy:- Hcg, hMG or pure FSH,
Dopamine agonist (cabergoline)
Divyesh

24.  General
 Drugs:- Clomiphene citrate, Letrozole, hMG, FSH, hCG, GnRH &
analogues, ,Dexamethasone, Bromocriptine ,Thyroxin, Antidiabetic
SURGERY
 Laparoscopic ovarian drilling (LOD) or laser vaporization
 Wedge resection & Reversal of tubal ligation
 Surgery for any tumor
 Uterovaginal surgery
 salpingo-ovariolysis. & Salpingography under fluroscopy
 Fimbrioplasty/fimbriolysis & Neosalpingostomy
 Adhesiolysis (Salpingoovariolysis)
 Tubotubal anastomosis & TubocornuaI anastomosis
Divyesh

25. Divyesh

26.  IVF-ET : In vitro fertilization and embryo
transfer
 GIFT : Gamete intra-fallopian transfer
 ZIFT : Zygote intra-fallopian transfer
 POST : Peritoneal oocyte and sperm transfer
 TET : Tubal embryo transfer zone
 SUZI : Subzonal insemination
 ICSI : Intracytoplasmic sperm injection
Divyesh

27.  AH : Assisted hatching
 IVM : In vitro maturation of oocyte
 PGD : Preimplantation genetic diagnosis
 Cryopreserveration : embryo/oocyte/ovarian
tissue/sperm
 Gestational Surrogacy
Divyesh

28.  Sperm Retrieval Techniques
 TESE : Testicular sperm extraction
 MESA : Microsurgical epididymal sperm
aspiration
 PESA : Percutaneous epididymal sperm
aspiration
Divyesh

29. Divyesh

30. Divyesh

31. Divyesh