Important topic

1. SARASWATI COLLEGE OF NURSING UDAIPUR , RJ
CASE PRESENTATION
ON
INFERTILITY
Submitted To: Mrs. HariBala Paliwal
(Associate Professor)
(Head of Deptt.)
OBG
Submitted By: Shabnam Amin
M. Sc. Nursing
(1st year)

2. ANATOMY AND PHYSIOLOGY

4. ANATOMY AND PHYSIOLOGY
•The reproductive system in men has components abdomen,pelvis
and perineum.
●SCROTUM: It is an out pouching of the lower part of the
anterior abdomen wall.
●TESTES: Testes is ellipsoid shaped.
Left testis is usually lying at the lower level than right.

5. ANATOMY AND PHYSIOLOGY
●EPIDIDYMIS: It is a single long coiled duct that courses along the
posteirolateral side of the testis.
●DUCTUS DEFERENS: Also called as Vas Deferens. It is a log
muscular duct that transports spermatozoa from tail of epididymis to
the ejaculatory duct.
●SEMINAL VESICLES: These are an accessory gland of the male
reproductive system.

6. ANATOMY AND PHYSIOLOGY
●EJACULATORY DUCTS: The function is to drain the seminal fluid
into prostatic urethra.
●PROSTATE: The prostate is an unpaired accessory structure of the
male reproductive system that surrounds urethra in the pelvic cavity.
●PENIS: The penis is a pendulous organ suspended from the front
and side of pubic arch and containing greater part of urethra.

7. ANATOMY AND PHYSIOLOGY

8. ANATOMY AND PHYSIOLOGY
•The uterus is a hollow, pear shaped muscular organ located in the true pelvis between the bladder and the
rectum.
SHAPE AND SIZE:
•It’s pear shaped, being flattened anterior-posteriorly.
MEASUREMENTS:
●Length- 3 inches (7.5cm)
●Breadth- 2 inches (5cm)
● Thickness- 1 inches (2.5cm)
●Weight- 50 to 80 grams

9. DEFINATION
●Infertility is defined as, “ Failure to conceive within one or more
years of regular unprotected coitus.”
●Primary Infertility: Those patients who have never conceived
is denoted as primary infertility.
●Secondary Infertility: Those patients who have conceived but
fails to conceive subsequently is denoted as secondary infertility.

10. FACTORS REQUIRED FOR FERTILIZATION
(Male & Female)
● Healthy spermatozoa should be deposited high in the vagina at or near the
cervix.
● Capacitation and acrosome reaction spermatozoa should undergo changes and
acquire motility in cervical canal.
● MOTILITY: Spermatozoa should ascend through the cervix into the uterine
cavity and fallopian tube.
● OVULATION: Ovum should reach the fimbriated end of the tube.
● Patent Fallopian tube: Fertilization should occur at the ampulla of the tube.
● Transportation of the fertilized ovum to the uterus cavity in 3-4 days the
fertilized ovum should reach the uterine cavity for negation.

11. CAUSES
(Male Factors )
1. Faults in male
● Defective Spermatogenesis
● Obstruction of efferent duct system
● Failure to deposit sperm high in the
vagina
● Errors in the seminal fluid
 CONGENITAL: Undecended testes
Kartagener syndrome
Hypospadiasis.

12. CAUSES
(Male Factors )
● THERMAL FACTORS:
Scrotal temperature is raised in conditions such as varicocele
● INFECTION: - Mumps orchitis.
- T. mycoplasma or Chlamydia trachomatis infection is also impacted
● GENERAL FACTORS:
- Chronic debilitating disease malnutrition or heavy smoking reduces
spermatogenesis.
-Alcoholism

13. CAUSES
(Male Factors )
● ENDOCRINE: Testicular failure
( Kallmann’s Syndrome)
● GENETIC: - Chromosomal Abnormality
- Klinefelter’s Syndrome
● IATROGENIC: - Radiation,
- cytotoxic drugs
-Nitrofurantoin, cimetidine, beta blockers,
anti hypertensive, anti convulsant drugs
● IMMUNOLOGICAL: Anti bodies against
spermatozoal surface antigens maybe cause
of infertility.

14. CAUSES
( Female Factors )
OVARIAN FACTORS
1) Anovulation or oligo-ovulation:
Disturbance in hormones can cause anovulation,
oligomenorrhoea or amenorrhea
2) Tubal and peritoneal factors: - Peritubal adhesions
Endosalpingeal damage
Previous tubal surgery
Salpingitis
Tubal or peritoneal endometriosis
Polyps within the lumen
Tubal spasm

15. CAUSES
(Female Factors)
•UTERINE FACTORS:

16. CAUSES
(Female Factors)
•CERVICAL FACTORS:

17. CAUSES
(Female Factors)
●VAGINAL FACTORS:
Atresia
Septum
Narrow introitus
●COMBINED FACTORS:
Age beyond 35 years ( female )
Infrequent intercourse
Apareunia
Anxiety
Use of lubricant during intercourse which maybe spermicidal
Immunological factors

18. INVESTIGATIONS
(Male)
●History
●Routine Investigations
●Semen Analysis
●Testicular Biopsy
●Transrectal Ultrasound
●Immunological Test

19. INVESTIGATIONS
(Female)
●History
●Physical Examinations
●Routine Examinations
● Endometrial Biopsy
● Sonography
● Laparoscopy
● Insufflation Test ( Rubin’s test)
● Hysterosalpingography
● Laparoscopic & Chromotubation
● Sonosalphingography
● Hysteroscopy

20. MANAGEMENT OF MALE INFERTILITY
1) General Care:
a) Improvement of general health
Reduction of weight in obese
Avoidance of heavy smoking and alcoholism
Avoidance of tight and warm undergarments
Avoidance of occupation that may elevate testicular temperature
b) Avoiding medications that interfere with spermatogenesis such as cytotoxic
drugs , Nitrofurantoin, cimetidine, anticonvulsants, antidepressants and beta
blockers.

21. MANAGEMENT OF MALE INFERTILITY
2)Medications to treat specific causes:
a)Human Chorionic gonadotropin (hCG) and Human Menopausal
gonadotropin (hMG) for hypogonad
b) Dopamine agonist (cabergoline) for hyperprolactinemia and altered
testosterone level and to improve libido potency and fertility
c) The GnRH therapy for hypogonadism
d) Clomiphene citrate to increase serum levels of FSH, LH and testosterone
e) Antibiotics for genital tract infections

22. MANAGEMENT OF MALE INFERTILITY
3)Special treatments for causes identified such as
a
) Intrauterine insemination (IUI)
b
) In Vitro fertilization (IVF)
c
) Intracytoplasmic sperm injection (ICSI)
d
) Artificial insemination with donor (AID) sperm
4)Surgical treatment:
e
)In men whose testicular biopsy shows normal spermatogenesis and obstruction
is suspected, vasoepididymostomy or vasovasostomy may help
f
) Correction of hydrocele

23. MANAGEMENT OF FEMALE INFERTILITY
1) For ovulatory dysfunction:
a) Induction of ovulation using drugs such as Clomiphene citrate,
Letrozole, FSH, hCG and GnRH
b) Correction of biochemical abnormality, Metformin for
hyperinsulinemia, Dexamethasone for androgen excess,
bromocriptine for prolactin excess.
c) Substitution therapy : Thyroxin for hyperthyroidism , antidiabetic
drugs for DM

24. MANAGEMENT OF FEMALE INFERTILITY
2)Surgery:
a) Laparoscopic ovarian drilling (LOD) or laser vaporization for Polycystic Ovarian
Syndrome (PCOS)
b) Surgical removal of virilizing or functioning ovarian or adrenal tumor
c) Tubotubal anasthomosis for adhesion in tube.
d) Cannulation and ballontuboplasty for block in the tube
e) Fimbrioplasty for fimbrial adhesion
f) Adhesiolysis for separation or division of adhesion
g) Salpingostomy to create an opening in the tube in a completely occluded tube

25. MANAGEMENT OF FEMALE INFERTILITY
h) Surgical removal of ovarian or adrenal tumor
i) Uterovaginal Surgery
j) Bariatric Surgery

26. TREATMENT
● ARTIFICIAL INSEMINATION:
Intrauterine Insemination (IUI)
Fallopian Tube Sperm Infusion
● ASSISTED REPRODUCTIVE TECHNOLOGY (ART)
In Vitro Fertilization and Embryo transfer (IVF-ET)
Gamete Intrafallopian Transfer (GIFT)
Zygote Intrafallopian Transfer (ZIFT)
● MICROMANIPULATION
Intracytoplasmic Sperm Injection (ICSI)
Embryo or Oocyte Donation
Gestational Carrier Surrogacy

27. NURSING MANAGEMENT
●When a couple presents with concerns about infertility, it is
important for nurse to understand that men and women are
very concerned and possibly emotional.
●Nursing interventions include assisting in reducing stress in
the relationship encouraging co operation, privacy and
understanding.

28. COMPLICATIONS
●Relationship Problems
● Depression
● Stress
● Ovarian Hyperstimulation Syndrome
● Ectopic Pregnancy
● Pelvic Infection
● Multiple Pregnancy
● Miscarriage
● Side effects of medications

29. HEALTH EDUCATION
LIFESTYLE MODIFICATION:
1. Alcohol: Consumption of alcohol affects the chances
of conception in both males and females
2. Smoking: Active or passive smoking while trying to conceive
can cause barrier in process.
3. Body Weight: Overweight or underweight of any partner
should be adequately dealt with to obtain equal optimal body
weight.
BMI>30decreases fertility

30. 4.Folic Acid Supplementation: It helps to decrease the birth defects
and improve sperm count. Eat green-leafy vegetables, citrus, beans ,
etc.
5. Ideal Coital Frequency: Intercourse on alternate days during fertile
period increases chances of pregnancy
6. Avoid stress