This study surveyed 370 women with infertility to examine the relationship between anxiety, depression, and the duration and cause of infertility. The results showed that 40.8% of women experienced depression and 86.8% experienced anxiety. Depression was related to the cause of infertility, duration, education level, and job. Anxiety was related to duration of infertility and education level. Anxiety and depression were most common after 4-6 years of infertility, and severe depression occurred most in those with infertility for 7-9 years. The conclusion is that psychological support and treatment is important for the mental health of these patients.

3. Infertility is defined as a
failure to conceive within one
or more years of regular
unprotected coitus.

4. It is of two types
 Primary infertility- it denotes those patients who have
never conceived.
 Secondary infertility- it indicates previous pregnancy
but failure to conceive subsequently.

5.  80% of couples achieve conception if they so desire within
one year of having regular intercourse with adequate
frequency (4-5 times a week).
 Another 10% by the end of 2nd year. Remaining 10% remain
infertile by the end of second year.
 According to research study 8% and 12% of couples suffers
from primary and secondary infertility worldwide with rate of
10% in India.

6.  Healthy Spermatozoa- Should be deposited high in the
vagina and near to the cervix.
 The spermatozoa should undergo changes like capacitation-
it is functional maturation of the sperm, acrosome reaction,
acquire motility.
 Motile spermatozoa,
 Ovulation should be there in females.

7.  Fallopian tubes should be patent, oocytes should be picked
up by the fimbriated end of the tube.
 Fertilization should occur at the ampulla of the tube.
 The embryo should reach to the uterine cavity after3-4 days
of fertilization.
 Endometrium should be receptive for implantation and the
corpus luteum should function adequately.

8. There are four main causes of infertility
 Male factor (30-40%)
 Female factor (40-55%)
 Combined factor (10%)
 Unexplained factor (10%)

9.  Defective spermatozoa
 Obstruction of the efferent duct system
 Failure to deposit sperm high in the vagina
 Errors in the seminal fluid

10.  Ovulatory dysfunction (30-40%)
 Tubal diseases (25-35%)
 Uterine factors (10%)
 Cervical factors (5%)
 Pelvic endometriosis (1-10%)

11.  Age beyond 35 years in female and male both.
 Infrequent intercourse
 Anxiety and depression
 Dyspareunia and apareunia
 Immunological factors
 Use of lubricants during intercourse, which may be
spermicide.

12. Objectives
 To detect the etiological factors.
 To rectify the abnormality in attempt to improve the
fertility.
 To give assurance with explanation to the couple if no
abnormality is detected.
When to investigate – according to definition the couple
should be investigated after one year but it shortened to 6
months after the age of 35 years in female and 40 years in
male.

13. What to investigate
the basic investigation should be carried out like
 Semen analysis
 Confirmation of the ovulation
 Confirmation of tubal patency

14. It is separate for both male and females
For male
History
 Age
 Duration of marriage
 History of previous marriage
 Sexual dysfunction
 Anosmia
Medical History- should be taken in reference to STD, mumps
orchitis after puberty, DM, recurrent chest infection,
bronchiectasis.

15.  Surgical History- enquiry about relevant surgery such as
herniorrhapy, operation of testes.
 Others – sexual history, erectile dysfunction, social habits,
heavy smoking or alcohol.

16. Physical Examination
 Thorough physical examination
 BMI
 Inspection and palpation of genitalia.
 Testicular size should be 20 ml measured by
orchidometer
 Presence of varicocele

17. Investigation
 Semen analysis
 Testicular biopsy
 Transrectal ultrasound
 Immunological test
 Karyotype analysis

19. For Female
History
 - General medical history
 - Surgical history
 - Menstrual history
 - Previous obstetrical history
 - Contraception used
 - Sexual problems.

20. Physical Examination
General examination
 BMI
 Secondary sexual characteristics
 PCOS
Systemic examination
 Accidently detection of such abnormalities hypertension, heart
diseases, chronic renal lesion, thyroid dysfunction etc.

21. Gynaecological examination
 It includes adequacy of hymenal opening, evidence of vaginal
infections, cervical tear, chronic infection, undue elongation of
cervix, uterine size, fixed or mobile with or without tenderness
and presence of nodules in the pouch of douglas.
Speculum examination
 May reveal abnormal cervical discharge, for gram stain and
culture.

22. Investigations
 Ovarian factors
 Endometrial biopsy
 Vaginal cytology
 Tubal factors
 Sonography
 Hysterosalpingography
 Laparoscopy
 Sperm cervical mucus contact test (SCMCT)

23. General instructions for couples
 Assurance
 Body weight
 Smoking and alcohol
 Coital problems

24. For Male infertility
 Improve general health.
 BMI (Body Mass Index)
 Medication should be avoided that interferes with
spermatogenesis
 Genetic abnormality
 AID (Artificial insemination with donor sperm)
 IVF with ICSI ( Intracytoplasmic Sperm Injection)
 Hormonal injections i.e. hCG 5000 IU IM once or twice a
week to stimulate endogenous and testosterone production.

25.  IUI ( intrauterine insemination)
 Testicular biopsy
 Surgery of varicocele
 Orchidoplexy within 2-3 years of age with undescended testes.
 For impotency psychosexual treatment.

26. For Female Infertility
 Identify causes
For anovulation
 Induction of ovulation by medications of hormonal injections
 Medication clomiphene citrate
 hCG (pregnyl)
 GnRH analogs
 FSH

27. For endometriosis
 Drugs and surgery
For cervical feature
 Cervical mucus improved by conjugated estrogen 1.25 mg
orally
For congenital anomalies
 Uterovaginal surgeries like myomectomy- to remove the
submucus fibroid.
 Metroplasty- to remove septum
 Enlargement of vaginal introitus
 Hysteroscopic polypectomy

28. For unexplained infertility
 Therapy
 Induction of ovulation
 IUI
 Superovulation with IUI
 ART
For combined infertility
 Both the partner should be treated simultaneously not one after
the other.

29.  Fear related to possible outcome of infertility.
 Situational low-esteem related to inability to conceive or
feeling of failure.
 Altered sexuality patterns related to structured efforts to
conceive or loss of spontaneity.
 Ineffective coping related to unmet expectations or feeling of
loss
 Deficient knowledge related to diagnostic and treatment
procedure

30.  In vitro fertilization (IVF) is the joining of a woman's egg
and a man's sperm in a laboratory dish. In vitro means outside
the body. Fertilization means the sperm has attached to and
entered the egg.
 IVF is a form of assisted reproductive technology (ART). This
means special medical techniques are used to help a woman
become pregnant. It is most often tried when other, less
expensive fertility techniques have failed.

31.  GIFT- Gamete intra-fallopian transfer
 ZIFT- Zygote intra –fallopian transfer
 IVF-ET- in vitro fertilization and embryo transfer
 ICSI- Intracytoplasmic sperm injection
 AH- Assisted hatching
 IVM- in vitro maturation of oocytes
 PGM- Preimplantation genetic diagnosis
 Cryopreservation- embryo/sperm/oocytes
 Gestational surrogacy

32.  IMSI (Intracytoplasmic morphologically selected sperm
injection)
 Laser assisted hatching
 PICSI- PICSI is a method of selecting the best possible sperm
for fertilization in the IVF protocol.

33. Now a days infertility become the major problem
towards the couples life due to this many couples broke
their families and live separately. It is essential to
council the couples and society about the infertility and
its treatment.

34. We have discussed about the infertility, incidence,
causes, investigation and treatment modalities and
ART.

35. A survey of relationship between anxiety, depression and
duration of infertility
Abstract
Background
A cross sectional study was designed to survey the relationship
between anxiety/depression and duration/cause of infertility, in Vali-
e-Asr Reproductive Health Research Center, Tehran, Iran.
Methods
After obtaining their consents, 370 female patients with different
infertility causes participated in, and data gathered by Beck
Depression Inventory(BDI) and Cattle questionnaires for surveying
anxiety and depression due to the duration of infertility. This was
studied in relation to patients' age, educational level, socio-
economic status and job (patients and their husbands).

36. Results
Age range was 17–45 years and duration and cause of
infertility was 1–20 years. This survey showed that 151
women (40.8%) had depression and 321 women (86.8%) had
anxiety. Depression had a significant relation with cause of
infertility, duration of infertility, educational level, and job of
women. Anxiety had a significant relationship with duration of
infertility and educational level, but not with cause of
infertility, or job. Findings showed that anxiety and depression
were most common after 4–6 years of infertility and especially
severe depression could be found in those who had infertility
for 7–9 years.

37. Conclusions
Adequate attention to these patients psychologically and
treating them properly, is of great importance for their mental
health and will improve quality of their lives.