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Infrtlty ppt

  1. 1. INFERTILITY
  2. 2. DEFINITION  Infertility is defined as a failure to conceive within one or more years of regular unprotected intercourse.  Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile
  3. 3. Pregnancy is the result of a process that has many steps. To get pregnant:  A woman must release an egg from one of her ovaries (ovulation).  The egg must go through a Fallopian tube toward the uterus (womb).  A man's sperm must join with (fertilize) the egg along the way.  The fertilized egg must attach to the inside of the uterus (implantation).
  4. 4. Types:  Primary infertility: refers to couples who have not become pregnant after at least 1 year of unprotected sex (intercourse).  Secondary infertility: refers to couples who have been pregnant at least once, but never again.
  5. 5. CAUSES OF INFERTILITY:  Common causes of infertility of females include:  ovulation problems  tubal blockage  age-related factors  uterine problems  previous tubal ligation  endometriosis
  6. 6. CAUSES OF INFERTILITY:
  7. 7.  Cancer or tumor  Clotting disorders  Diabetes  Growths (such as fibroids or polyps) in the uterus and cervix  Birth defects that affect the reproductive tract  Excessive exercising  Eating disorders or poor nutrition  Use of certain medications, including chemotherapy drugs
  8. 8.  Drinking too much alcohol  Obesity  Older age  Ovarian cysts and polycystic ovary syndrome (PCOS)  Pelvic infection or pelvic inflammatory disease (PID)  Scarring from sexually transmitted infection or endometriosis  Thyroid disease  Too little or too much hormone.
  9. 9.  Male infertility may be due to:  A decrease in sperm count  Sperm being blocked from being released  Sperm that do not work properly  heavy alcohol use  drugs  environmental toxins, including pesticides and lead  smoking cigarettes
  10. 10.  health problems such as mumps, serious conditions like kidney disease, or hormone problems  Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin  Radiation treatment and chemotherapy for cancer  Being in high heat for prolonged periods  Birth defects  Too little or too much hormones
  11. 11.  Impotence  Infection  Older age  Scarring from sexually transmitted diseases, injury, or surgery  Retrograde ejaculation
  12. 12. INVESTIGATION OF INFERTILITY:  General medical history  Surgical history  Menstrual history  Previous obstetrical history  Contraceptive history  Sexual problems
  13. 13.  Diagnostic TestsBlood and imaging tests will be done. In WOMEN, this may include:  Blood tests to check hormone levels, including progesterone and follicle stimulating hormone  Checking body temperature first thing in the morning to check if the ovaries are releasing eggs
  14. 14.  Hystero-salpingography (HSG)  Pelvic ultrasound  Laparoscopy  Luteinizing hormone urine test (ovulation prediction)  Thyroid function tests
  15. 15.  Some common tests of fertility in women include:  Hystero-salpingography: This is an X-ray of the uterus and Fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the uterus and Fallopian tubes.  .
  16. 16.  This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the Fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
  17. 17.  Laparoscopy: A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope .She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, Fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
  18. 18.  During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, Fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy
  19. 19. 1.HISTORY 2.GENERAL EXAMINATION 3.LOCAL EXAMINATION 4.SPECIAL INVESTIGATION
  20. 20. # SEMEN ANALYSIS A normal semen analysis show: ~semen volume:1.5 to 5 ml ~concentration:>20 million sperm/ml ~total sperm count:>50 to 60 million Any abnormality in this result will show chances of infertility.
  21. 21. # POSTCOITAL TEST # SPERM PENETRATION TEST # TESTICULAR BIOPSY # IMMUNOLOGICAL TESTS # CHROMOSOMAL STUDIES
  22. 22.  Male factor infertility account for about half of all infertility problems. Problems for the male can include:  Lack of Sperm -AZOOSPERMIA  Abnormal Sperm- TERATOSPERMIA  Absence of semen-ASPERMIA  Impaired motility of sperm- ASTHENOSPRMIA  Dead sperms-NECROSPERMIA
  23. 23. TREAT INFERTILITY IN MEN  Sexual problems: help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.  Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, surgically remove sperm directly from the male reproductive tract..
  24. 24.  Antibiotics can also be used to clear up infections affecting sperm count.  Sperm movement: Sometimes semen has no sperm because of a block in the man's system. In some cases, surgery can correct the problem.
  25. 25. Tests in MEN may include: In men, -by testing the semen. Normal semen values as suggested by WHO :  Volume - 2.0 ml or more  pH - 7.2 -7.8  Sperm concentration – 20 million / ml or more  Total sperm count - 40 million per ejaculate
  26. 26.  Motility – 50 percent or more progressive forward motility  Morphology – 15 percent or more normal form  Viability – 75% or more living  Leucocytes – Less than 1 million/ ml
  27. 27. TREATMENT OF INFERTILITY IN WOMEN  Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
  28. 28.  Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
  29. 29.  Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
  30. 30.  Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
  31. 31. Testosterone:It improves testicular function. Testosterone patch is applied directly to the scrotum (TESTODERM) OR ANDRODERM. Sildenafil (Viagra): It improves ERECTILE DYSFUNCTION
  32. 32.  Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production .
  33. 33. ASSISTED REPRODUCTIVE TECHNOLOGY (ART):  Success rates vary and depend on many factors. Some things that affect the success rate of ART include:  age of the partners  reason for infertility  clinic  type of ART  if the egg is fresh or frozen  if the embryo is fresh or frozen
  34. 34.  Common methods of ART include:  Intrauterine insemination (IUI):  In vitro fertilization (IVF) .  Zygote intra fallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF.  Gamete intra fallopian transfer (GIFT)  Intra cytoplasmic sperm injection (ICSI)  Surrogacy  Gestational Carrier
  35. 35.  Intrauterine insemination (IUI):  Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.  IUI is often used to treat:  Mild male factor infertility  Women who have problems with their cervical mucus  Couples with unexplained infertility
  36. 36.  In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's Fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
  37. 37.  Zygote intra fallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the Fallopian tube instead of the uterus.
  38. 38.  Gamete intra fallopian transfer (GIFT) involves transferring eggs and sperm into the woman's Fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.
  39. 39.  Intra cytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or Fallopian tube.
  40. 40.  ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby.
  41. 41.  An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
  42. 42. SPERM DONATION There are selected groups of patients to whom sperm donation is recommended.
  43. 43.  #TUBAL REVERSAL  A common dilemma many individuals face if they've previously had a tubal ligation is whether they should undergo a microscopic tubal ligation reversal vs. an In Vitro Fertilization (IVF) procedure. While a tubal reversal does require more skill than an IVF procedure, a tubal reversal is actually the better option for most patients. THE success rate with microsurgical tubal reversal is about 95% if and only if the surgeon has good skill.  IT needs one small incision n 1 day hospitalization.
  44. 44.  #MICROSCOPIC VASECTOMY REVERSAL  Vasectomy Reversal is a procedure which allows men who have previously undergone vasectomy to become fertile again. The vas deferens is microsurgically reconnected and the epididymal blowouts are microsurgically bypassed, allowing sperm to travel out of the epididymis and into the EJACULATION
  45. 45. MICRO ASSISTED FERTILIZATION(MAF) IT occurs in vitro and is expensive used in * IVF or GIFT fails * Immunological derived infertility * Inability of sperm to penetrate egg
  46. 46. IN VITRO FERTILIZATION (IVF)  Definition:In vitro fertilization (IVF) is a procedure in which eggs (ova) from a woman's ovary are removed. They are fertilized with sperm in a laboratory procedure, and then the fertilized egg (embryo) is returned to the woman's uterus.
  47. 47.  In vitro fertilization (IVF) is the joining of a woman’s egg and a man’s sperm in a laboratory dish. In vitro means “outside the body.” Fertilization means the sperm has attached to and entered the egg.
  48. 48. Purposes:  IVF is one of several assisted reproductive techniques (ART) used to help infertile couples to conceive a child. If after one year of having sexual intercourse without the use of birth control a woman is unable to get pregnant, infertility is suspected.
  49. 49. Preparation  The woman may be given a sedative prior to the procedure. A local anesthetic agent may also be used to reduce discomfort during the procedure.
  50. 50. Method:  Step 1: Stimulation, also called super ovulation  Step 2: Egg retrieval  Step 3: Insemination and Fertilization  Step 4: Embryo culture  Step 5: Embryo transfer
  51. 51. Step 1: Stimulation, also called super ovulation
  52. 52. Step 2: Egg retrieval
  53. 53. Why the Procedure Is Performed  Advanced age of the woman (advanced maternal age)  Damaged or blocked fallopian tubes (can be caused by pelvic inflammatory disease or prior reproductive surgery)  Endometriosis  Male factor infertility, including decreased sperm count and blockage  Unexplained infertility
  54. 54. Risks  IVF requires a significant physical, emotional, financial, and time commitment. Stress and depression are common among couples dealing with infertility.  fertility drugs may cause ovarian hyperstimulation syndrome (OHSS), decreased urination despite drinking plenty of fluids, nausea, vomiting, and shortness of breath.
  55. 55. Complications Multiple Births Birth defects
  56. 56. Aftercare  After the IVF procedure is performed the woman can resume normal activities. A pregnancy test can be done approximately 12-14 days later to determine if the procedure was successful.
  57. 57.  Women who undergo IVF must take daily shots or pills of the hormone progesterone for 8 - 10 weeks after the embryo transfer. Progesterone is a hormone produced naturally by the ovaries that helps thicken the lining of the womb (uterus). This makes it easier for the embryo to implant. Too little progesterone during the early weeks of pregnancy may result in a miscarriage.
  58. 58. ROLE OF NURSE IN INFERTILITY MANAGEMENT  ASSESSMENT  The nurses role during this stage is to educate the couple about each test and investigation, including why and how this investigation to be performed.  The nurse plays a vital role in alleviating the fear and anxiety about the various diagnostic procedure.
  59. 59.  TREATMENT  The nurse plays the link between the doctor and couple and should always be available to couple for their assistance , guidance and support before . during and after infertility treatment.  Numerous ethical issues are associated with infertility treatments and the couple under going treatment need appropriate counseling and discussion.
  60. 60.  EDUCATION  The role of nurse in educating the patients includes education about the basic male and female anatomy and physiology and how the drug acts on their body, including possible side effects.  Fertility nurse should also educate the couple about self administer medications.
  61. 61.  PREVENT infertility by  Avoid gonadotoxins  Decrease exposure to occupational and environmental hazards  Avoid transmission of STDs by limiting the number of sexual parteners and by using condoms  Eating a well balanced and nutritious diet.  Stopping smoking and drinking.
  62. 62.  PSYCHOLOGICAL SUPPORT  A couple undergoing infertility treatment are usually stress due to a variety of reason. Because infertility evaluation and treatments are expensive , time consuming ,invasive ,stressful and not always successful and also not socially acceptable. Proper emotional support and guidance is required by the couple at this stage.
  63. 63.  The nurse as a counselor should provide anticipatory advice and guidance about the normal range of expectations and reasons throughout the treatment.
  64. 64. Any question ?
  65. 65. THANK YOU

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