Infertility is defined as the failure to conceive after one year of unprotected intercourse. It affects approximately 15-20% of couples. The document defines and discusses the various causes and types of female and male infertility as well as diagnostic tests, medical and surgical treatment options, and assisted reproductive technologies. Advanced technologies like IVF, IUI, and ICSI are discussed as treatment options when other methods are unsuccessful. The nurse's role in supporting infertile couples through counseling, education and reducing stress is also summarized.

2. :
 Infertility is a disease of reproductive system
defined by the failure to achieve a clinical
pregnancy after 12 month or more regular.
 Infertility is the inability of a sexually active,
non-contracepting couple to achieve pregnancy in
1 year .
Infertility is defined as failure to conceive after 1 year
of unprotected coitus.

3. •
 15-20%
 80% couple conceive at the end of 12 month.
 Increasing incidence is due to late marriage,
delaying pregnancy, increase number of MTP,
increase awareness of treatment , unknown
reason.

4. •
1. Primary infertility:
It is infertility in a couple who have
never had a child.
2. Secondary infertility:
It is to failure to conceive following a
previous pregnancy and miscarriage.

5. CONT…
3. Unexplained infertility:
When all the investigation in male and
female are normal then, it is called
unexplained infertility.

6. CAUSES OF INFERTILITY

7. • CAUSES OF INFERTILITY
A. Female causes:
1) Ovarian Factor
- Unovarian or oligo-ovulation
- Decreased ovarian reserve
- Luteal phase defect.
- Lutinized unruptured follicular syndrome.

8. CONT….
2) Pelvic infection:
- Peritubal adhesion
- Endosalpangeal damage
- Tubal endometriosis
- Polyps or mucus debris.
3) Peritoneal factor:
- Peritubal adhesion
- Minimal endometriosis
- Deep dysparenuia.

9. CONT…
4) Anatomical factor:
- Anatomic defect preventing sperm due to
congenital elongation of cervix second degree
uterine prolapse.
5) Physiological factor:
- The fault lies in composition of the cervical
mucus so spermatozoa fail to penetrate to mucus.

10. CONT…
6) Uterine factor:
- Uterine hypoplasia
- Fibroid uterus
- Endometriosis
7) Vaginal factor
- Atresia vagina (partial) or complete transverse
vaginal septum.
8) Combined factor:
- Apareunia and dyspareunia
- Anxiety and apprehension.

11. CONT…
B) Male factor:
1) Defective Spermatogenesis
- Chromosomal
- Hypothalamic pituitary failure
- Testicular failure
- Undescended testies
- Varicocele

12. CONT…
2) Obstruction in the passage
- Congenital absence of vas
- Blocked vas due to infection.
- Blocked vas due to hernia repair.
3) Ejaculatory problem
- Frequency and timing of intercourse
- Hypopadiasis
- Impotence: erectile dysfunction
- Premature or retrograde ejaculation.

13. CONT…
4) Immunological problems
- Spermal antibodies
- Cervical mucus antibodies
5) Medical condition
- Diabetes Mellitus
- Tuberculosis
- Mumps
- Hypertension
- Smoking.

14. CONT…
C) General Causes:
i. Advance age of the wife beyond 35.
ii. Infrequent intercourse, lack of knowledge of coital
technique.
iii. Apareunia and dyspareunia
iv. Anxiety and apprehension.
v. Use of lubericant during intercourse which may be
spermicidal
vi. Immunological factor.
vii. Iatrogenic factors

15. • DIAGNOSTIC EVALUATION
A) In female:
i. History collection
ii. Menstrual history
iii. General examination
iv. Systemic examination
v. Gynecological examination
vi. Endometrial biopsy
vii.Sonography

16. CONT…
viii. Laparoscopy
ix. Hysterosalpingography
x. Sonosalpingography
xi. Ovulation test
xii.Basal metabolic test
xiii. Stretch test

17. CONT…
B) In Male
i. History collection
ii. Semen analysis
iii. Blood test
iv. Testicular biopsy

18. • MANAGEMENT
• There are 7 step to treating infertility:
STEP 1
Understand the importance of age, medical condition and relationship status
STEP 2
Change your lifestyle
STEP 3
Sexual intercourse (Get the timing right)

19. STEP 4
General practitioner Consultation
STEP 5
Flinders fertility Consultation (Consultation with one of our
fertility specialists)
STEP 6
Diagnosis
STEP7
Treatment Plan

20. MEDICAL MANAGEMENT

21. MEDICAL MANAGEMENT
A) Medical management in male:
i. Retrograde ejaculation: Ephedrine 600 mg orally 4 times OR
Alpha adrenergic drug.
e.g. Phenylephedrine
ii) Antibiotic : To treat infection like prostatis, STD.
e.g. Doxycycline 100 mg for 6 weeks.
iii) Hormonal therapy
- HCG- 10000 IU IM weekly for 10 weeks. (To improve testoteron
secretion.

22. B) Medical Management in female
i. Ovulation should induced.
e.g. Clomiphene citrate 50 mg 2-6 days of cycle.
ii. To avoid peripheral suppressive action of estrogen on cervical
mucus and improve fertility rate.
e.g. Letrozole 25 mg
iii) Clomiphene Citrate + Human menopausal gonadotropin (hmG)
CC 50 to 100 mg/day+hmG 75 unit.
iv) Prednisolone :- in women with inovulation.

23. CONT…
v) Hyperprolactinemia is treated with bromocriptin 1: 25mg at
bedtime.
vi) Clomiphene 25mg daily for 25 day followed by rest for 5
day.
vii) Human menopausal gonodropin 150 IU thrice a week for a
6 month.
viii) Dexametasone 0.5 mg daily:- If presence of spermal
antibodies.
ix) Cyclosporin 5-10mg/kg daily for 6 month.
x) Sildenafil (Viagra) 25-100mg 1hour before intercourse
improve errectile function.

24. SURGICAL MANAGEMENT

25. SURGICAL MANAGEMENT
A) In male
a) Epididymastomy or vasvasotomy
For normal spermatogenesis obstruction of vas must be
suspected.
b) Hydrocele is corrected by surgery.
c) Orchidopexy in undecended testis should be done.

26. B) In female
a) Laparoscopic ovarian drilling or laser
b) Wedge resection
c) Surgery for pituitary prolactinomus
d) Peritubal adhesion
e) Proximal tubal block

27. Advance technology used in infertility
Assisted reproductive technology(ART)
i. Invitro fertilization and Embryo transfer (IVF&ET)
ii. Gamete intrafallopian transfer(GIFT)
iii. Zygote intrafallopian transfer (ZIFT)
iv. Intrauterine insemination (IUI)
v. Intracytoplasmic sperm injection (ICSI)

28. NURSES RESPONSIBILITY
• The nurse should provide psychological support to the
couples.
• The nurse should have important intervention when working
with infertile couple.
• Assisting in reducing stress.
• Encouraging co-operation.
• Protecting privacy, fostering understanding.

29. CONT…
• Smoking is strongly discouraged, having severe adverse effect
on reproduction.
• Recent technology like sperm and egg donation, invitro
fertilization , donar insemination the nurse should give proper
information about that.