For nursing students

1. INFERTILITY
 PRESENTED
BY
 Miss Daminee
Patel

2. DEFINITION
 Infertility is define as failure to conceive after 1 year of
unprotected sexual intercourse.
 Lippin cott
 Infertility is strict define as the inability to conceive after
one year of unprotected regular sexual intercourse.
 D.C.Dutta

3. INCEDENCE OF INFERTILITY

4. FACTORS CONTRIBUTING TO
INFERTILITY
 Disturbance in spermatogenesis( production of
sperm cell)
 Obstruction in somniferous tubules, duezor
vessles preventing movement of spermatozoa.
 Qualitative and quantitative changes in seminal
fluid preventing sperm motility.
 Development of autoimmunity that mobilize
sperm.
 Problems in ejaculation or deposition preventing
spermatozoa from being placed close enough to
the women cervix to allow ready preparation and
fertilization.

7. ETIOLOGY OF INFERTTILIY
0%
5%
10%
15%
20%
25%
30%
35%
40%
Male Female Combine Unexplained

8. MALE FACTORS
1. SPERM PRODUCTION PROBLEM
 Azoospermia
 Oligospermia
 Tetrazoospermia
 Asthenozoospermia
 Necrozoospermia
 Undescended testis
 Varicocele
 Infections

9. BLOCKAGE OF SPERM TRANSPORT
 Congenital absence of vas deference
 Vasectomy

10. SEXUAL PROBLEM
 Premature
ejaculation
 Failure to ejaculation
 Erectile dysfunction
 Spinal cord injury.
 CHROSOMAL
ABNRMALTIES
 Klinefelter syndrome
 Mixed gonadal
dysgenesis

11. SUBSTNCE ABUSE
 Alcohol smoking and caffeine – Excessive alcohol
smoking and caffeine lowers the testosterone level
and sperm quality in men. It can also reduce libido
and cause impotence.

12. FEMALE FACTORS
 OVULATORY DYFUCTION
 Anovulation
 Oligo ovulation

13. DECREASED OVARIAN RESERVE
 The number of resting non growing
primordial follicle refers to as the ovarian
reserve. The main reason for decreasing
ovarian reserve is -
 Advance maternal age
 Premature ovarian failure
 Resistant ovary syndrome

14. TUBAL FACTORS
 Pelvic infections
 Tubal pregnancy
 Endometriosis
CONGENITAL
ABNORMALTIES
Turner syndrome – Is
monosomy of second sex
chromosomes. It is a
chromosomal condition
that affects development in
female. In turner syndrome
loss of ovarian function
and. It cause the infertility.

15. AQUIRED ABNORMALTIES
 Acquired abnormalities
like endometrial polyp
and intrauterine
adhesion can must
interfere the
implantation and
collection of dense
fibrous in some case so
ii affect the women
infertile.

16.  CERVICAL FACTORS
 PERITONEAL FACTORS
 Disease of peritoneal cavity may cause infertility,
Infertility due to peritoneal polyp.
 Peritubal and periovarian adhesion and tubal
abstructtion cause infertility.
 Kinking ( twisting) of fallopian tube.
 ANTISPERM ANTIBODIES

17. UNEXPLAINED FERTILITY
 Unexplained infertility accounts for 10% cases of
infertility. A diagnosis of unexplained fertility made
when all investigation are normal, but also present in
infertility.

18. PATHOPHISIOLOGY
 MALE
Due to blockage of sperm
transport
Inhibit the meeting of ovum
and sperrm
Absence of fertilization
It causes infertility

19. FEMALE
Due to ovulatory dysfunction
Absence of release of ovum
It inhibit the meeting the sperm and
ovum because of anavulation
Absence of fetilization
It cause infertility

20. DIAGNOSTIC EVALUATION OF
INFERTILITY
 HISTARY TAKING
 PHYSIICAL EXAMINATION
 SPERM ANALYSIS

21. Immuno beads are small beads that are treated with
special proteins. If antibodies to sperm are present,
these beads will attach to the sperm. One hundred
motile (swimming) sperm are evaluated for bead
attachment. For the male, if twenty or more of these
sperm have beads attached to them (a result of 20%
or greater), this is considered a positive test and
indicates that antisperm antibodies may be present.
For the female, a result greater than 10% is
considered a positive test.
ANTISPERM ANTIBODY TESTING

22. SPERM PENETRATION ASSAY
 Sperm penetration studies are
laboratory test to determine
whether sperm, once they reach
the ova, can penetrate the ova.
 Using a artificial reproductive
technique such as in vitro
fertilization.
 The number of sperm that
penetrate the egg is measured.
 Results are based on the number of
sperm that can penetrate the egg
 Normal – sperm penetrate
 Abnormal - Sperm cant penetrate
the egg.

23. SCROTAL ULTRASOUND
HORMONE
TESTING
POST
EJACULATION
URINALYSIS
GENETIC
TESTING
TRANSDUCTAL
ULTRASOUND
FERTILITY
TESTING

24. FEMALE
 DETERMINATION OF OVULATION
 By basal body temperature
 Determination by cervical mucus assessment
 Determination by strip
 ASSESSMENT OF OVARIAN RESERVE (
AMH TESTING)
 ASSESSMENT OF THE FALLOPIAN TUBES
AND UTERUS
 Hysterosalpingogram (HSG)

25. Genetic testing
 Laparoscopy
 Hysteroscopy

26. MANAGEMENT
 MALE PARTENR
 Antisperm antibodies
 Retrograde ejaculation
 Lifestyle
 SURGICAL CARE
 Varicocelectomy
 Vasovasostomy or vasoepididymostomy
Electroejaculation

27. Important
Nutrients for
Male Fertility
Health
Zinc
Folic acid
B12
Vitamin C
Eat at least one
large green salad
per day

28. FEMALE PARTNER
 Correction of underlying problem
 Assisted Reproductive Technology or
ART: Assisted reproductive
technology (ART) is the technology used to
achieve pregnancy in procedures such
as fertility medication, in vitro
fertilization and surrogacy. It is reproductive
technology used primarily
for infertility treatments, and is also known
as fertility treatment.

29. TYPE
S
GIFT
IVF
– ET
IUI
ZIFT
ICSI

30. ARTIFICIAL INSEMINATION (AI)
 INDICATION
 The women has a vaginal
or cervical factor
interfering with sperm
motility.
 Man has a known genetic
disorder and he dose not
want to transmitted to
offspring or the women
has no male partner.

31.  It is useful for the male for who underwent a
vasectomy now wish to have children.
 Main types of artificial insemination
intrauterine insemination (IUI) and
 intra cervical insemination (ICI),
PROCEDURE
 CONTRAINDICTION

32. IN VITROFERTILIZATION AND EMBRYO
TRANSFER
 In Vitro Fertilization is an assisted reproductive
technology (ART) commonly referred to as IVF. IVF is
the process of fertilization by extracting eggs,
retrieving a sperm sample, and then manually
combining an egg and sperm in a laboratory dish. The
embryo(s) is then transferred to the uterus.
 INDICTION
 Damage follopian tube
 Decreased sperm count
 Genetic and ovulation disorder

33. PROCEDURE

34. GAMETE INTRA FALLOPIAN TUBE
TRANSFER (GIFT)
 GIFT is an assisted
reproductive procedure
which involves removing a
woman’s eggs, mixing them
with sperm, and
immediately placing them
into a fallopian tube.
 PROCEDURE
 INDICATION
 ADVANTAGES AND
DISADVANTAGES

35. ( ZIFT) ZYGOTE INTRAFOLLOPIAN TUBE
TRANSFER

36. PROCEDURE
 A woman’s ovaries are stimulated with medications to
increase the probability of producing multiple eggs.
 Eggs are then collected through an aspiration procedure.
 Those eggs are fertilized in a laboratory in a procedure
identical to IVF, with the exception of the time frame.
During the ZIFT procedure, fertilized eggs are
transferred within 24 hours, versus 3-5 days as used in a
regular IVF cycle.
 The fertilized eggs are then transferred through a
laparoscopic procedure where a catheter is placed deep
in the fallopian tube and the fertilized eggs injected.
 The final step is to watch for early pregnancy symptoms.
The fertility specialist will probably use a blood test to
determine if pregnancy has occurred.

37. INDICATINON
 Tubal blockage
 Significant tubal damage
 An anatomic problem with the uterus, such as severe
intrauterine adhesions
 Sperm that is not able to penetrate an egg

38. ADVANTAGES DISADVANTAGES
 The main advantage is that
the pregnancy rate increases,
since the gametes are not
inserted separately but only
those which have been
previously fertilised.
 Those who support or use this
technique stress that this
procedure is similar to
natural fertilization, since the
embryo spends a shorter
period of time outside its
natural environment and,
thus, its quality improves.
 One of its main
disadvantages is that ectopic
pregnancy is more likely to
happen. Moreover, an
invasive surgery is required,
which implies greater levels
of difficulty and potential
risks.
 It is also worth to mention
that, since more than one
zygote can be inserted, the
rates of multiple
births, miscarriage, and
other problems derived from
pregnancy are higher if
compared to other
techniques.

39. INTRACYTOPLASMIC SPERM
INJECTION
 One single spermatozoon or even a
spermatid is injected directly into the
cytoplasm of the oocyte by micro
puncture of the zona pellucida. Micro
pipette is used to hold the oocyte
while spermatozoa is deposit inside
the cytoplasm.
 INDICATION
 Azospermia
 Faliure to fertilization
 Unexplained fertility

40. OTHER TECHNIQUE
 SURROGATE EMBRYO TRANSFER

41. ALTERNATIVES TO CHILDBIRTH
 SURROGATE MOTHER
 ADOPTION
 CHILDFREE LIVING

42. ADOPTION PROCEDURE
 MEANING
 Adoption is the process
through which a child
becomes the lawful child of
his adoptive parents. He
will have all the rights,
privileges and
responsibility of a
biological child.

43. Who can be adopted?
 An orphan
 An abandoned child
 A surrendered child

44. WHO CAN ADOPT?
 Any Indian, NRI or foreign citizen can adopt a child,
though the procedure for all three is different.
 Any male or female irrespective of their marital
status is eligible to adopt.
 A single female can adopt a child of any gender but a
single male cannot adopt a girl child.
 If a couple is adopting, they should have two years of
stable marriage and consent of both the spouses is
necessary.
 Age difference should not be less than 25years
between the adoptive parents and the adoptive child.

45. CONDITIONS TO BE FULFILLED
 The prospective parents should be emotionally,
mentally and physically stable.
 They should be financially capable to raise a child.
 They should not have more than four kids.
 They should not be suffering from a life threatening
disease

46. Procedure followed for adoption of a child
 Prospective parents register online or can reach District
Child Protection Officer (DCPO) to register the
prospective parents online. The application form is
available atwww.cara.nic.in.
 The adoption agency prepares a Home Study report
describing the various factors and circumstances of the
family within one month of the registration.
 The home study report shall be posted on the database by
the adoption agency.
 The parents are given chance to choose their prospective
child based on their preferences.
 They are shown photographs, child study reports and
medical examination reports of up to six children.

47.  The prospective adoptive parents may reserve one child
within a period of forty eight hours for possible adoption
and the rest of the children would be released for other
prospective parents.
 The adoption agency will fix the meeting of the
prospective adoptive parents to access whether they are
suitable parents or not. The parents should also be
allowed to have a meeting with the child.
 The entire process of matching should not take more than
fifteen days.
 While accepting the child the prospective adoptive parents
should sign the Child Study Report in presence of social
worker.
 If prospective parent do not accept the child or the child
do not accept the parent then same procedure will be
followed for other chances.

48. LEGAL AND ETHICAL ISSUES THAT ARE
REGULATED INCLUDE
 The use of donor sperm and eggs: for example,
anonymity is guaranteed in law for donors in Greece, but no
longer allowed in the UK.
 The use and payment of surrogates: for example,
commercial surrogacy is banned in many countries but is
completely legal in India.
 The in vitro development period allowed for
embryos: for example, in many countries, embryos are
allowed to develop for several days to allow selection of the
healthiest candidates but in others only early embryos can be
implanted.


49.  The selection process for embryos, including sex
selection and genetic screening: for example, pre-
implantation genetic diagnosis (PGD) is banned in some
countries but allowed under strict regulations in others.
 The maximum number of embryos that can be
transferred: for example, many countries have strict
single embryo transfer policies, while others will leave the
number of embryos implanted up to the discretion of the
fertility specialist.
 The maximum storage time for frozen embryos: for
example, Spain and Canada allow unlimited storage,
whereas Brazil has a limit of just three years.