lesson plan on infertility

1. S.no ContributoryObjectives Time ContentMatter Teaching
Learning
Activities
A V aids Chalk
board
Plus
01.
At the endof the teachingthe students
will be able to
To introduce the female reproduction
process
02min
05min
INTRODUCTION OF SELF
Myself, samitasambyal , today
I m goingto teachyou about
infertility.
INTRODUCTION ABOUT TOPIC
For pregnancyto occur every
part of complex humans
reproductionprocesshasto
take place justright.The stepin
thisprocesshas follow:-
1. One of the twoovaries
release amature egg.
2. The egg ispickedupby
the fallopiantube.
3. Spermswimupthe
cervix , throughthe
uterusand intothe
fallopiantube toreach
the egg forfertilization.
4. The fertilizedeggtravel
downthe fallopiantube
to the uterus.
5. The fertilizedegg
implantsandgrow in
the uterus.Inwomen,
numberof factors can
disruptthisprocessat
any step.Female
infertilityiscausedby
thisone or more factors
like anatomical and
physiological.Some of
these are treated.
Definition
INFERTILITY:
Accordingto WHO “ infertility
can be describedasthe inability
to become pregnant,maintaina
pregnancyor carry a pregnant
to live birth.”
Lecture
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Discussion
Lecture
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discussion
Black
board

2. To define the infertilityandfemale
infertility.
To enumerate the type of infertility
To discussthe causesof female
infertility
PREVIOUS KNOWLEDGE:
Do youhave any previous
knowledge aboutinfertility?
Female infertility
“female infertilityreferstoa
female inabilitytoconceive bya
fertile male ormaintain
pregnancyto live birthin
human.
It account for40-50%.
TYPE
Primary
Infertilitydenotesthose
patientswhoneverconeived.
Secondary
Infertilityindicate previous
pregnancybutfailure to
conceive subsequently.
CAUSES OFFEMALE INFERTILITY
The responsible causes
percentage ovulatoryfactor
(30-40%), tubal andperitoneal
factor (25-35%),and
endometriosis(1-10%)
OVULATIONFACTOR=
1.ANOVULATIONOR
OLIGOOVULATION
The ovarianactivitytotally
dependonthe gonadotrophins
and the normal secretion
dependuponthe GnRH From
hypothalamus.Ovarian
dysfunctional islikedtobe
Listening
and
writing
notes
Lecture
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discussion
Learning
and
writing
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Lecture
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Discussion

3. linkedwithdisturbed
hypothalmo-pituitary-ovarin
AXIS
2. LUTEAL PHASE DEFECT = In
thisconditionthere inadequate
functionof the corpusluteum.
there isinadequate
progesterone secretion.the life
span of corpus luteumis
shortenedtolessthan10 days
.as a resultthere isinadequate
secretorychangesinthe
endometrium,whichhinder
implantation.
3. LUTENISED UNRUPTURED
FOLLICULAR SYNDROME
(TRPPED OVUM) In this
conditionthe ovumistrapped
inside the folliclewhichget
lutinised.
4. DECREASE OVARIN RESERVE
TUBAL AND PERITONEAL
FACTORS =
 Perituabal adhesion
 Endosalpingeal damage
 Previoustubal surgery
 Tubal endometriosis
 Polypsormucus debriswithin
the tubal lumen,ortubal spasm
 Peritoneal infection UTERINE
FACTOR
 Uterine hypoplasia
 Inadequate secretory
endometrium,
 fibroiduterus
 endometritis
 congenital malformationof
uterus
CERVICAL FACTOR=
ANATOMIC=anatomicdefect
preventingspermascentmay
be due to congenital elongation
of the cervix ,seconddegree
uterine prolapse andacute
retroverteduterus.These
conditionpreventthe external
OS to bathe inthe seminal pool
Listening
and
writing
notes
Lecture
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discussion

4. , or polyps
 PHYSIOLOGIC=the faultliesin
the compositionof the cervical
mucus, so much that the
spermatozoafail topenetrate
the mucus . the abnormal
constituentsinclude excessive,
viscouspurulentdischarge asin
chroniccervicitis,presence of
antispermAb
VAGINALFACTORS
Atresiavagina
 Transverse vaginal septum,
 septate vaginaornarrow
introituscausingdysparenia
 vaginitisandpurulent
discharge
OTHER FACTOR =
1. ADVANCE AGE- more than
35 yearsthe reproductive year
progress, the no.and qualityof
the egg diminish.the chance of
havinga babydecrease by3 -5
% .
2. CHRONIC ILL HEALTH
3. HORMONAL FACTOR-
pituitaryglanddysfunction
Hyperprolactinaemiaand
hypothalamicdisorder
4. COMBINED FACTOR=
Anxiety,apprehension,
inadequate orinfrequentinter
course , sexual intercourse,
immunological factor
.&psychological andsubstance
abuse , education,STI
INVESTIGATIONOF
INFERTILITY
OBJECTIVE OF INVESTIGATION
 TO Detectthe etiological
factor factor
 To rectifythe abnormalityin
an attemptto improve the
fertility.
Learning
and
writing
notes
Lecture
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discussion

5. To enlistthe variousinvestigation
 To give assurance with
explanationtothe couple if no
abnormalitydetect.
Whento investigate ? Asper
definitioninfertilecouple
shouldbe investigate.
afterone year of regular
unprotectedsex.The intervalis
shortenedto6 monthafter the
age of 35 yearsof the woman.
And40 years of man.
What to investigate?
1. semenanalyasis
2. confirmationof ovulation
3. confirmationof tubalpatency
FEMALE INVESTIGATION
HISTORY TAKING
1 A genral medical history
2 Surgical history
3 Menstrual history
4 Previousobstetrichistory
5 Contraceptive practice
6 Sexual problem
EXAMINATION –
1 General examination
2. Systemicexamination
3 .Gynaecological examination
4 .Speculumexamination
SPECIAL INVESTIGATION
Noninvesible orminimal
invasive methodare tobe
employedpriortomajor
invasive one .
OVARIAN FACTORS- Diagnosis
of ovulationare asfollow
Indirect, direct, conclusive
Indirect–menstrual history
Evalutionof peripheral or
endogenschanges.
Lecture
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discussion
Learning
and
discussion
Lecture
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discussion

6. A)BASALBODYTEMPERATURE
B) CERVICALMUCUS STUDY
c) VAGINALCYTOLOGY
D) HORMONE ESTIMATION
Serumprogesterone
LH
Endometrial biopsy
E)Sonography
Direct
Laproscopy
Conclusive
Pregnancy
MANAGEMENTOF FEMALE
INFETILITY
The treatmentof female
infertilityare groupedasfollow
accordingto disorderidentified
OvulatoryTubal Associated
disorderlike endometriosis
Cervical Immunological
UnexplainedinfertilityUtero
vaginal canal Assisted
reproductive technology
General drugs
Surgery
General
 Psychotherapy
 Reductionof weightinobesity
or improve the weightif low
weight.
Drugs
STIMULATION OF OVULATION
 Clomiphenecitrate
Lecture
cum
discussion

7.  Letrozloe
 h MG(PERGNOL)
 FSH(METRODIN)
 h CG(PROFSI)
 GnRH
 GnRH Agonist
CORRECTION OF BIOCHEMICAL
ABNORMALITY
Hyperinsulinaemia- metformin
Androgenexcess-
dexamethasone
Prolactinraised –bromocriptine
SUBSTITUTION THERPY
Hypothyrodism-tyroxin
DM-antidiabeticdrugs
Surgery ovarian
 Laproscopicovariandrilling
OR laservaporisation
 Surgeryfor pituitary
prolactinomas
 Surgical removal of ovarianor
adrenal tumour
Tubal and peritoneal factors
 by laproscopyorlaprotomy
 cannulationandballon
tuboplasty .
 fimbrioplasty –releaseof
fimbrial adhesionordilationof
fimbrial phimosis.
 Neosalpingostomy-tocreate
anew tubal openinginan
occuldedtube .
 Tubotubal anastomosis
 Adjuvanttherapy –include
antibiotics,hyrotubation
Endometriosis
Treatedby surgeryor
medication
Cervical factor
Oestrogen1.25 mg orallydaily
startingon day8-5 days

8. Explainthe managementof female
infertility
Antibioticsif infectionoccur
doxycycline 10mg twice daily
Immunological factor
Dexamethasone0.5mg at bed
timeinthe follicularphase
Gilliantype operationtocorrect
thirddegree retroversion
inunexplainedinfertility.
UTEROVAGINALSURGERY
MYOMECTOMY METROPLASTY
ADHESIOLYSISwithinsertionof
IUCD
FENTON OPERATION –
enlargementof the vaginal-
oitus
Unexplainedinfertility
the recommendedtreatment
for unexplainedinfertilityare-
INDUCTIONOF OVULATION
INTARUTERINE INSEMINATION
/ ARTIFICALINSEMINATION
FALLOPIAN TUBE SPERM
PERFUSION
ASSISTEDREPRODUCTIVE
TECHNOLOGY
IVF –ET=IN VITROFERTLIZATION
ANDEMBRYO TRANSFER
GIFT = GAMETE INTRA –
FALLOPIAN TRANFER
ZIFT= ZYGOTE INTRA
FALLOPIAN TRANSFER
ICSI = INTRA CYTOPLASMIC
SPERMINJECTION EMBRYO OR
OCCYTE TRANSFER
GESTATIONALSUROGACY
Prevention
Some strategiessuggestedor
proposedforavoidingfemale

9. infertilityinclude the following:-
 Avoidingstressasitchanges
hormonal function.
 Avoidingsubstance abuse&
alcohol use.
 Make a propersexual
relationshipwithherpartner
.  IF the female don’tconceive
,take adequate treatment
 Avoidfalse contraceptive and
any mediactionpractice
Summarization:
Today , we have discussed
aboutthe variouskeyterms,
definitionof female infertility,
itscauses,the various
investigationsusedfordiagnosis
and the management&
preventionof female infertility.

12. To discussthe preventivemeasure of
female infertility

13. Recaptulization
Assignment:
Define female infertility.Discuss
the managementof female
infertilityindetails.
Bibliography:
 VG Padubidri &SN Daftary ,
‘’Howkins&Bourne Shaw’s
Textbookof Gynecology’’,
FifteenthEdition,ElsevierIndia
Private Limited,2011, Pp200-
209
 D.C.Dutta,‘’Textbookof
Gynecology’’,FifthEdition,New
central bookagency(P) Ltd,
Kolkata,2006, Pp 220-226