Obstetric And gynecological Nursing Community Health Nursing Medical Surgical Nursing

1. PRESENTATION
ON
By-
Harshika S. Tembhurne

2. INTRODUCTION
Infertility is define as couple’s inability to achieve pregnancy
following one year of appropriately timed and unprotected
intercourse. Infertility effect about 10% of all couple. 20-30% of
infertility cases are due to male infertility, 20-35% are due to, and
25-40% female infertility are due to combined problems in both
parts. In 10-20% of cases, no cause is found

3. Definition
Infertility
infertility is defined as failure to conceive within one or two more year of
regular unprotected intercourse.
Sub-fertility
Sub-infertility refer to a state in which a couple has tried unsuccessfully to have
a child for year or more. The term sub-fertile means less fertile than regular
couple.
Primary infertility
primary infertility denote couples who have never been able to conceive.
Secondary infertility

4. FACTOR REQUIRED FOR FERTILITY
For male and female
Healthy spermatozoa
Motility
Ovulation
Patent fallopian tube
Transportation of fertilized ovum to
uterine cavity
Acrosome reaction

5. CAUSES OF INFERTILTIY
INFERTILTIY
MALE FEMALE COMBINE

6. CAUSES IN MALE
DEFECTIVE SPERMATOGENESIS
Congenital
Hypospadias
Thermal factor
Infection
Gonadotropin suppression
Endocrine factor
Loss of sperm mobility
Genetic
Iatrogenic
Immunological factor
OBSTRUCTION OF THE EFFERENT DUCTS

7. Cont…….
FAILURE TO DEPOSIT SPERM HIGH IN
VAGINA
Erectile dysfunction
Ejaculatory defect such as retrograde,
premature, absence of ejaculation
Hypospadias
ERROR IN SEMINAL FLUID
Unusually high or low volume of ejaculate
Low fructose content
High prostaglandin content
Undue viscosity.

8. CAUSES IN FEMALE
OVARIAN FACTOR
An-ovulation or oligo-ovulation.
TUBAL AND PERITONEAL FACTOR
Peritubal adhesion
Endosalpingeal damage
Salpingitis
Previous tubal surgery or sterilization
Tubal or peritoneal endometriosis
Polyps within lumen
Tubal spasm

9. UTERINE FACTOR
Uterine hyperplasia
Inadequate secretary endometrium
Fibroid
Endometritis
Congenital malformation
CERVICAL FACTOR
Chronic cervicitis
Presence of anti sperm antibody
Congenital elongated of cervix
Second degree uterine prolapse
Acute retroversion of uterus
Occlusion of cervical canal with polyp
Pinhole OS
Scanty vaginal mucus

10. VAGINAL FACTOR
Atresia
Septum
Narrow introitus
COMMON FACTOR
Age of wife beyond 35 and advance age in
male.
Infrequent intercourse during fertile
period
Failure of emission of sperm/ejaculation
Anxiety
Use of lubricant
Immunological factor

11. INVESTIGATION
For female and male

12. HISTORY TAKING
 General History
 Medical history
 Surgical history
 Menstrual history
 Pervious obstetric history
 Contraceptive practice
 Sexual problem
INVESTIGATION FOR FEMALE

13. PHYSICAL EXAMINATION
General examination : obesity, abnormal
distribution of hair, under development of
secondary characteristic.
Systemic examination : hypertension,
organic heart disease, chronic renal
disease.
Gynecological examination : evidence of
vaginal infection, elongation of cervix,
uterine size.
Speculum examination : cervical discharge

14. DIAGNOSTIC EVALUATION
• Menstrual history
• Basal body temperature
• Hormonal estimation
• Endometrium biopsy
• hysterosalpingography
• Sonography
• Laparoscopic chromotubation• Sonosalpingography
• Insufflation test

15. INVESTIGATION FOR MALE
HISTORY TAKING
• Age
• Duration of marriage
• Contraceptive use
• Sexual dysfunction
• Anosmia

16. General medical history
• Diabetes
• Recurrent chest infection
• Bronchiectasis
• Mumps orchitis after puberty
• Surgery such as herniorrhaphy
• Operation on tests
• Erectile dysfunction
• Heavy smoking and alcohol
Diagnostic evaluation
• hormonal test
• Testicular biopsy
• Transrectal ultrasound
• Karyotype analysis

17. MANAGEMENT OF
INFERTILITY

18. GENERAL INSTRUCTION
oBODY WEIGHT
oSMOKING AND ALCOHOL
oIDEAL COTIAL FREQUENCY
oUSE OF LH SURGE KIT
oAVOIDANCE OF LUBRICANTS
AND DOUCHES TO BE STRESSED
oPSYCHOLOGICAL EFFORT

19. MANAGEMENT IN MALE
GENERAL CARE
 IMPROVEMENT OF GENERAL HEALTH
 AVOIDING MEDICATION THAT INTERFERE WITH
SPERMATOGENESIS
 MEDICATION THAT TREAT SPECIAL CAUSES LIKE
ANTICONVULSANT
 SPECIAL TREATMENT : INTRAUTERINE INSEMINATION, INVITR
FERTILIZATION, INTRACYTOPLASMIC SPERM INJECTION.
 SURGICAL TREATMENT : TESTICULAR BIOPSY
 CORRECTION OF HYDROCELE.

20. FEMALE INFERTILTIY
MANAGEMENT
 ovulatory dysfunction
 surgery
• laproscopic ovarian drilling
• surgical removal of virilizing
• cannulation and balloon tuboplasty for block
in treatment
• salpingostomy to create opening in tube in a
completely occluded tube

21. ASSISTED
REPRODUCTIVE
TECHNOLOGY [ART]

22. TECHNIQUE OF ART
Intrauterine insemination (IUI)
In-vitro fertilization and embryo transfer (IVF-ET)
gamete intra-fallopian transfer (GIFT)
zygote intra-fallopian transfer (ZIFT)
Intra cytoplasmic sperm injection (ICSI)

23. Intrauterine insemination (IUI)
It involve placing increasing concentration of
motile sperm close to fallopian tube by passing
endocervical canal.
 Indication
• Cervical stenosis
• Oligo-spermia
• Immune factor
• Unexplained infertility
• Anatomical defect
These are of type
1. Artificial insemination donor
2. Artificial insemination husband

24. In-vitro fertilization and embryo transfer (IVF-ET)
The fertilization of ovum
occur outside the body
technique is used in
blocked fallopian tube.
 Indication
• Tubal disease
• Endometriosis
• Cervical hostility
• Unexplained infertility

25. gamete intra-fallopian transfer (GIFT)
In this procedure both the
sperm and unfertilized oozyte
are transferred into fallopian
tube using laparoscopy
following transvaginal ovum
retrieval

26.  zygote intra-fallopian transfer (ZIFT)
In zygote intrafallopian transfer,
egg cells are removed from the
women’s ovaries and fertilized in
lab. The resulting zygote is then
placed in fallopian tube
following one day invitro-
fertilization through laproscope
or through uterine opening
under ultrasonic guidance. The
technique is suitable alternative
to gift

27. Intra cytoplasmic sperm injection (ICSI)
This method is beneficial in case of
male factor infertility where the sperm
count are low or failed fertilization
with previous IVF attempts. The
procedure involve single sperm
carefully injected into center of egg
using a micro-needle.
 Indication
• Sever oligospermia
• Sperm antibodies
• Obstruction of afferent duct
system

29. Legal and ethical aspect of ART
1.Clinics should be registered
2. Code of practice
• Staff
• Facilities
• Confidentiality
• Information to patient
• Consent
• Counselling
• Use gametes and embryo
• Storage and handling the gametes and embryo
• Research
• Complaints

30. Cont……
3.Responsibility of clinic
• Maintance of detail record
• Take DNA finger print of
donor/child/couple/surrogate mother if couple
agrees.
• Keep information confidential
• Display the charge suitably or made down to
known to patient at beginning of treatment.
Ensure that no. technique is used on patient which
demonstrated expertise.

31. ADOPTION
Adoption is when a child grew in its mommy's heart instead of her tummy…………

32. ADOPTION
It is legal process by which a child is placed with married couple or single
female who agree to rise her as their own child and assume responsibility
for her.
Law governing adoption
• Hindu adoption and maintenance act of 1956
• Guardian and ward act of 1890
• Juvenile justice act of 2000

33.  Condition to be fulfilled by an adoptive
parent.
 Medically fit and financially able to care for
child
 Must be at least 21 yr. age
 No legal upper age limit for parents
 Adoption of older age children, age of
parents will be relaxed
 Adoption of child with special needs, the age
limit of parents will be relaxed
 If adoption is son/ daughter, the adoptive
father or mother by whom the adoptive is
made must nit have same gender living at
time of adoption.

34. HINDU ADOPTION AND MAINTENANCE ACT-
1956
PREOCESS
Step1- registration
Step2-home study and counselling
Strp3-referral of child
Step4-acceptance of child
Step5-filing of petition
Step6-court hearing
Step7-court order
Step8-follow up

35. summary