Infertility is defined as the failure to achieve a clinical pregnancy after 12 months of regular unprotected sex. It can be primary infertility, which means a couple has never conceived, or secondary infertility, which means previous pregnancy but failure to conceive subsequently. There are many potential risk factors and causes of infertility for both men and women, including age, medical issues, lifestyle factors, and physical problems. Diagnostic procedures involve medical histories, physical exams, lab tests, and imaging to evaluate fertility and identify any treatable conditions for both male and female partners. Counseling supports patients coping with infertility, facilitates decision making around treatment options, and helps achieve a better quality of life.

1. PRESENTED BY
LAMNUNNEM HAOKIP
MSC (N) 1ST YEAR
UNDER THE SUPERVISION OF
DEBIKA MA’AM

3. DEFINITION
• Infertility is "a disease of the reproductive system
defined by the failure to achieve a clinical pregnancy
after 12 months or more of regular
unprotected sexual intercourse (and there is no other
reason, such as breastfeeding or
postpartum amenorrhea).

4. TYPES
PRIMARY
SECONDARY
INFERTILITY

5. • PRIMARY INFERTILITY: It denotes those couples who
have never conceived even once.
• SECONDARY INFERTILITY: It indicates previous
pregnancy but failure to conceive subsequently.

6. RISK FACTORS FOR INFERTILITY
• Age: A women over 35 years of age and men over 40
years of age.
• Diabetic person.
• Eating disorders, including anorexia nervosa and
bulimia.
• Excessive alcohol use.
• Exposure to environmental toxins such as leads and
pesticides.
• Over exercising.
• Radiation therapy or other cancer treatments.

7. CAUSES OF INFERTILITY
FLIP CARDS

8. WOMEN:
Ovulation disorders
• Premature ovarian failure (before the age of 40).
• Polycystic ovarian syndrome.
• Hyper-prolactinemia.
• Poor egg quality.

9. Uterus and fallopian tube
• Any surgery .
• Sub-mucosal fibroids.
• Endometriosis.
• Previous sterilization treatment.
• Salpingitis

10. Vaginal factors
• Atresia (Partial or complete).
• Septum of vagina.
• Narrow introitus.
Medications
• NSAID’s (aspirin and ibuprofen).
• Chemotherapy.
• Radiotherapy.
• Illegal drugs.

11. MEN
Defective spermatogenesis
• Congenital: Undescended testes where the vas
deferen is absent.
• Hypospadias: Failure to deposit sperm high in vagina.
• Thermal factor: Rise in body temperature due to
varicocele, big hydrocele, tight undergarments.

12. • Infection: Mumps orchitis after puberty.
• Loss of sperm motility( asthenozoospermia and
abnormal sperm morphology).
• Iatrogenic: Radiation, cytotoxic drugs, nitrofurantoin
etc.

13. Obstruction of efferent ducts
• Obstructed by gonococcal or tubercular infections.
Surgical trauma during vasectomy.
Failure to deposit sperm high in vagina
• Erectile dysfunction
• Ejaculatory defects.

14. DIAGNOSTIC
PROCEDURES OF
INFERTILITY
CHART

15. MALE
• History and physical examination: Age, duration of
marriage, contraception used, any sexual
dysfunction.
• Semen Analysis: Helps to show the level of sperm
production and whether sperm are functioning well.
• Transrectal Ultrasound: A probe is placed in the
rectum it beams a sound waves to the nearby
ejaculatory ducts. It is use to see the structures of
ejaculatory ducts or seminal vesicles are poorly
formed or blocked.

16. • Testicular Biopsy: If a semen shows very low number
of sperm or no sperm, testicular biopsy is needed.
• Hormonal profile: This is to check how well the
testicles make sperm and also can rule out major
health problems.

17. WOMEN
• History and physical examination: Age, duration of
marriage, previous surgical and medical history
(Obstetrics), any contraceptives practice, any sexual
problems.
• Hysterosalpingogram(HSG): This is an x-ray procedure
to see if the fallopian tubes are open or not and to see
the uterine cavity.
• Laparoscopy and Chromopertubation: For detection of
tubal patency, block, motility, any changes in the
endometrium, PCOS.

18. • Transvaginal Ultrasonography: An ultrasound probe
is placed in the vagina to check the uterus and
ovaries for any abnormalities such as fibroids and
ovarian cysts.
• Ovarian reserve testing: To find out whether the
women can produce an egg of good quality and how
well is the ovaries are responding to hormonal
signals from the brain.

19. INFERTILITY COUNSELING
• Infertility counselling deals with the psycho-social
impact of infertility in terms of- intervention,
treatment and after-effects of both successful and
unsuccessful treatments. It also involves therapeutic
work to help patient cope with the consequences of
infertility and treatment.

20. OBJECTIVES AND NEED OF INFERTILITY COUNSELLING
• Informed consent.
• To offer coping strategies to couples.
• To facilitate decision making.
• To offer preparation for procedures.
• To help client in achieving a better quality of life.
• To provide genetic counselling.

21. COUNSELING SERVICES:
• IVF-group discussion by staff.
• Third party reproduction for both donors and
recipients.
• Therapeutic counselling.
• Assessment and follow up

22. NURSES RESPONSIBILITIES
• Make the patient or couple comfortable with the
counseling.
• Obtain history of both the couples
• Explain the plan of care and treatment
• Maintain confidentiality
• Ensure follow up care

24. BIBLIOGRAPHY/REFERENCE
• Annamma Jacob, A comprehensive textbook Midwifery and
Gynaecological Nursing, 4th Edition. Jaypee Brothers. pg no.
857-866.
• DC Dutta’s, Hiralal Konar, Textbook of Gynecology, 7th Edition.
Jaypee Brothers. pg 186-209.
• Lily Podder, Fundamentals of Midwifery and Obstetrical
Nursing. ELSEVIER. pg 295-310.
• https://www.urologyhealth.org/urology-a-z/m/male-
infertility
• https://www.mayoclinic.org/diseases-conditions/female-
infertility/diagnosis-treatment/drc-
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