Infertility is defined as the inability to conceive after one year of unprotected intercourse, classified as primary or secondary infertility. Contributing factors include male factors, ovulation issues, tubal/uterine problems, and unexplained causes, with various treatments available like medications, hormonal therapy, and surgical options. Diagnostic assessments involve hormonal testing, imaging studies, and semen analysis to determine the underlying causes and guide treatment.

1. INFERTILITY
PRESENTED BY DR CLOTILDA CHUMA

2. DEFINITION
• Infertility is defined as the inability to conceive after 1 year of
unprotected intercourse of reasonable frequency.
• It can be subdivided into primary infertility, that is, no prior
pregnancies, and secondary infertility, referring to infertility following
at least one prior conception.

3. etiology
• Male 25%
• ovulation 27%
• tubal/uterine 22%
• Other 9%
• Unexplained 17%

4. etiology
• Endometriosis
• Interference with tubal patency
• Endometrial fragility
• Adhesions that displace the ovaries
• Treatment
• Laparoscopy
• Cautery
• Hormonal Rx

5. • Tubal Blockage
• Scarring (PID)
• Fibroids
• Uterine Problems
• Tumors
• Congenital Anomalies

6. • Anovulation
• Genetic – Turners Syndrome, Hypogonadism
• Problems with the Hypothalamus
• Pituitary-ovarian hormonal feedback mechanisms
• Hypothyroidism
• Stress
• Decreased body weight

7. • Anovulation
• Treatment
• Menotropins – Pergonal, Repronex (medications made up of gonadotropins
extracted from the urine of postmenopausal women)
• GnRH Agonist – Lupron, Synarel (synthetic versions of GnRH’s)

8. • Cervical Mucus Problems
• Vaginal Infections
• Hormone Deficiencies
• Treatment
• HRT
• Cryosurgery
• Guaifenesin

9. Etiology
• Varicocele – varicose of swollen vein in the testicle
• Cryptorchidism – undescended testicle at birth
• Restrictive undergarments
• Occupational exposure to heat
• Working in a seated position

10. assesment
• Current or past reproductive tract problems
• Endocrine problems
• Abdominal or pelvic surgeries
• Use of vaginal douches or medications (interfere with pH)
• Occupational exposure to x-ray or toxic substances

11. • Menstrual History
• Age of menarche
• Length, regularity, & frequency of menstrual periods
• Amount of flow
• Dysmenorhea / PMS
• Contraceptive use
• Hx. Previous pregnancies or abortions

12. • Basal Body Temperature (BBT)
• Oral temp taken each day prior to arising
• Results are graphed
• Sudden dip occurs the day prior to ovulation & is followed by a rise of 0.5 –1.0
degrees F, which indicates ovulation

13. • Serum Hormone Testing
• Venous blood is drawn to assess levels of FSH and LH
• These are indicators of ovarian function

14. • Endometrial Biopsy
• Paracervical Block to decrease cramping / pain
• Pinch of endometrium obtained to check for a luteal phase defect (lack of
progesterone)
• Pre-procedure Care
• Instruct the client to undress below the waist
• Assist on exam table

15. • Current or past reproductive tract problems
• Endocrine problems
• Abdominal or pelvic surgeries
• Use of vaginal douches or medications (interfere with pH)
• Occupational exposure to x-ray or toxic substances

16. • Hysterosalpingogram (HSG)
• Detects uterine anomalies (septate, unicornate, bicornate)
• Detects Tubal anomalies or blockage
• laparascopy

17. • Semen analysis
• Ejaculates into a specimen container
• Ejaculate examined for:
• Number
• Morphology
• Motility

18. • Volume >2.0 mL
• pH 7.0 – 8.0
• Total sperm count >20 million per mL
• Motility 50% or greater
• Normal forms 50% or greater

19. Treatment
• Medications
• Clomiphene citrate (Clomid, Serophene) – used to increase FSH and LH
secretion, thereby stimulating ovulation
• One IM dose of HCG may be administered to stimulate release of the ova
from the follicles

20. • Intrauterine Insemination (a form of artificial insemination)
• Sperm are collected within 3 hours of colitus and are inserted via a catheter
into the uterus
• Donor sperm may be used
• Identify of the sperm donor is kept confidential

21. • THANKS