nursing

2. INTRODUCTION
• Reproduction (or making a baby) is a simple
and natural experience for most couples.
However it is for some couples it is very
difficult to conceive. There are many causes of
infertility, including some that medical
intervention can treat. About 40% of the
issues involved with infertility are due to the
man, another 40% due to the women, &
20%result from complications with both
partners.

4. DEFINITION
• Infertility - It is defined as the couple’s inability to achieve
pregnancy after 1 year of unprotected intercourse.
• Both infertility and subfertility are defined as the
inability to conceive after a certain period of time (the
length of which vary), so often the two terms overlap.
• Infertility is grouped into two categories:-
• Primary infertility – refers to couple who has not become
pregnant after atleast one year of unprotected intercourse.
• Secondary infertility – refers to couples who have been
pregnant atleast once, but are not able to get pregnant
now.

5. MALE INFERTILITY
• It refers to a male’s inability to cause
pregnancy in a fertile female. In humans it
accounts for 40-50% of infertility.

8. Causes
1)Genetic
• Abnormal Y chromosome & XXY in klinefelter’s
syndrome
2) Disorders of spermatogenesis
• a) Hormonal (pre- testicular)
• Hypothalamic disorder
• Pituitary secretion of FSH,LH
• Hyperprolactinaemia causing impotence or diminished
libido
• Hypothyroidism, adrenal gland disorder & diabetes

9. b) Primary testicular disorders (testicular)
• idiopathic, varicocle
• chromosomal defect, i.e. klinefelter’s syndrome
• cryptorchism
• drugs, radiation, calcium channel blockers,
anticonvulsants, antihypertensive, spironolactone
& cimetidine
• orchitis (traumatic, mumps, TB, gonorrhea)
• chronic illness
• Immunological disorders (5%)
• Immobility due to absence of dynein arms.
Absent cilia in kartgener’s syndrome (15%)

10. 3) Duct obstruction ( post- testicular)
Congenital absence, inflammatory block
(gonococcal, tubercular), surgical trauma,
young’s syndrome (inspissated mucus)
associated with sinusitis & bronchiectasis,
chlamydial infection.
4) Accessory gland disorders
Prostatitis, vesiculitis & congenital absence
of vas in cystic fibrosis

11. 5) Disorders of sperm & vesicular fluid
• Sperm antibodies & low fructose in seminal
plasma. Immotile cilia syndrome (kartagener’s
syndrome)
• sperm acrosome defect
• zona pellucida binding defect
• zona penetration defect
• oocyte fusion defect
6) Sexual dysfunctions
• low frequency coitus – wrong time
• impotence, hypospadias, decreased libido
• premature ejaculation
• retrograde ejaculation

12. 7) Psychological & environmental factors
Like smoking, alcohol consumption, tobacco
chewing, diabetes & drugs – antihypertensive,
antipsychotics, cimetidine, sex steroids (excess
testosterone & anabolic used by athletes)
chemotherapy, nitrofurantoin, β- blockers,
spironolactone, oestrogen.
8) Other causes
• being in high heat for prolonged periods
• obesity
• older age
• strenuous riding (bicycle riding, horse riding)

15. INVESTIGATIONS
• History
• General examination
• Local examination
• Special investigations
• Semen analysis
• Blood test to check hormone levels
• Ultrasound of the male genitals
• Testicular biopsy
• Immunological test
• Patency of vas
• Chromosomal study
• Post – coital test
• Sperm penetration test
• Semen cervical mucous

17. MANAGEMENT OF MALE
INFERTILITY
Management is mainly based on the assessment of coital
functions, semen examination & the result of the postcoital
& immunological tests, as well as hormonal reports.
• Education
• Substance abuse
Advice on avoidance of tobacco (smoking, chewing),
moderation in consumption of alcohol & avoidance of drug
abuse.
• Reduce heat around the scrotum
• Correct endocrinopathies
Prompt attention to diabetes & thyroid disorders

18. • Hormone therapy Various regimens have been
applied with variable results. Like:
hCG, testosterone, clomiphene, Human
menopausal gonadotropine (hMG), GnRH,
tamoxifen, dexamethasone, sildenafil (Viagra)
• ix) Artificial insemination

19. Management of azoospermia
• With oligospermia or abnormal semen, obstructive as
well as non-obstructive azoospermia, the couple may
be offered:-
• In vitro fertilization (IVF)
• Gamete intrafallopian transfer (GIFT) technique
• Micro assisted fertilization (MAF) technique
• Microsurgical epididymal sperm aspiration (MESA) or
percutaneous epididymal sperm aspiration (PESA)
• Testicular biopsy, sperm retrieval & MESA supersede
other methods in modern treatment of male infertility
& with improved success.

21. Prevention
Some strategies suggested or proposed for avoiding male
infertility include the following:-
• Avoiding smoking as it damages sperm DNA
• Avoiding heavy marijuana & alcohol use
• Avoiding excessive heat to the testis
• Sperm counts can be depressed by daily coital activity and
sperm motility may be depressed by coital activity that take
place too infrequently (abstinence 10-14 or more)
• When participating in sports such as baseball, football,
cricket, hockey, wrestling, karate etc. wear a protective cup
& jockstrap to protect the testicles.