INFERTILITY AND ITS MANAGEMENT IS A LIGHTNING TOPIC OF OBSTETRICS AND GYNAECOLOGY. ALL THE METHODS OF INFERTILITY MANAGEMENT ARE DISCUSSED IJN THIS SLIDE.

1. CLASS PRESENTATION ON :-
INFERTILITY AND ITS
MANAGEMENT
:- PRIYANSHU ANAND
B.Sc Nursing 4th Year
O.I.N.S.R. DAMOH (M.P.)

2. :-
• INTRODUCTION TO INFERTILITY
• DEFINITION OF INFERTILITY
• TYPES OF INFERTILITY
• ETIOLOGY/CAUSES
• RISK FACTORS
• DIAGNOSTIC INVESTIGATIONS
• MANAGEMENT OF INFERTILITY
• PREVENTION OF INFERTILITY

3. :-
• Infertility a disease of reproductive system
due to which the couples are unable to have
child.
• The inability to have child affects couples and
causes emotional and psychological distress in
both men and women.

4. • Despite the various social, psychological,
economic and physical implications, infertility
prevention and care often remains neglected
public health issues or at least they rank low
on the priority list, especially for low-income
countries that are already under population
pressure.

5. According to World Health Organization,
“Infertility refers to inability to achieve
pregnancy after 12 months of having
unprotected sexual intercourse with average
frequency of 3-4 times per week without use
of any birth control measures.”

6. INFERTILITY
PRIMARY
INFERTILITY
SECONDARY
INFERTILITY

7. • PRIMARY INFERTILITY :- It means that the
couple has never conceived earlier. Globally
most couples suffer from this type of
infertility.
• SECONDARY INFERTILITY :- It means that the
couple has experienced a pregnancy before
and failed to conceive later.

8. 1. MALE FACTORS :-
– Defective Spermatogenesis
– Obstruction of efferent duct
– Failure to deposit sperm
– Seminal fluid errors

9. 2. FEMALE FACTORS :-
– Ovarian factors
– Uterine Factors
– Cervical factors
– Vaginal factors
– Tubal and peritoneal factors
– Combined factors

10. 3. FACTORS INFLUENCING BOTH SEXES :-
– Environmental/ Occupational factors
– Toxic effects due to tobacco, alcohol, drugs, etc.
– Excessive exercise
– Inadequate diet associated with extreme weight
loss or gain
– Advanced age.

11. • Age
• Smoking
• Over-weight
• Over-exercise
• STDs
• Frequency and timing of sexual intercourse
• Mental stress

12. As we know that both male and female factors
can contribute to infertility. To check for
infertility, following tests are done :-
• HISTORY TAKING :- Couples are interviewed
separately or together to know about causes of
infertility. Full history includes : present history,
menstrual and obstetric history, contraceptive
and sexual history, family planning and past
history.

13. • CLINICAL EXAMINATION :- Full clinical
examination of both partners is required for
detection of any physical problem. It includes
general examination alongwith examination of
chest, breast, abdomen and genitalia.
• INVESTIGATIONS :- Infertile couples are usually
advised to start their investigations after 12
months of trying to conceive or after 6 weeks if
the female partner is more than 35years of age or
immediately if there is an obvious cause for their
infertility.

14. Investigations include the following :-
SEMEN ANALYSIS :- It should be done after 72 hours
of sexual abstinence and two analysis should be
advised within 3 months apart at the same lab.
Results may be interpreted for its volume, sperm
count, motility and morphology.
Investigations for female partner include :-
o Detection of ovarian functions
o Hormonal Assay :- FSH and LH levels and mid-
luteal progesterone levels.

15. o Transvaginal Ultrasonography :- It is used for
detection of ovulation in females and any
abnormality in uterus and adnexa (adjoining
anatomical parts of the uterus).
o Evaluation of tubal patency
(HYSTEROSALPINOGRAPHY) (HSG) :-It’s a
radiologic procedure. The dye is inserted into the
uterus through cervix and simultaneously x-ray
pictures are taken to see the movement of dye
into the fallopian tubes. Spilling of dyes into
abdominal cavity shows that tubes are patent.

16. Advanced investigations include :-
o Hormonal Assay :- Thyroid function test, prolactin
level, testosterone and other tests if polycystic ovary
syndrome is suspected.
o Laparascopy :-It is a surgical procedure used to
visualize abdominal and pelvic organs.
o Hysteroscopy :- It is indicated for intra uterine space-
occupying lesions detected on HSG.
o Chromosomal Karyotyping :- For suspected genetic
disorders.
o Testicular Biopsy :- A fine needle aspiration biopsy to
differentiate between obstructive and non-obstructive
azoospermia.

17. Management of infertility ranges from
counselling and advice to medications and
surgery.
General instructions for management are :-
• Maintainance of body weight.
• Avoid smoking and alcohol.
• Maintain ideal coital frequency (3-4 times/week).

18. • Avoid use of contraceptives.
• Avoid fertility impairing medications.
• Psychological support.
• Promote regular exercise.
• Folic acid supplementation in women.

19. Apart from these general instructions
following are the management methods for
infertility :-
Management
Medical
ART
Surgical

20. Medical Management :-
• Estrogen modulators
• Anti-diabetic meication
• Hormonal medication

21. Surgical management :-
• Surgical removal of tumor
• Balloon tuboplasty
• Fimbrioplasty
• Adhesionolysis

22. ART (Assisted Reproductive Technique)
“It involves direct retrieval of oocytes from
ovary, manipulation of gametes and embryos
outside body for purpose of establishing
pregnancy.”

23. Some techniques of ART are :-
• IUI (Intrauterine Insemination) :- IUI is the
placement of men’s sperm into a woman’s uterus
using a long narrow tube. It may be used in
conditions such as defects of cervix, low sperm
count, sperm with low motility, erection
problems, etc.
– It is of two types :-
1. Artificial insemination by husband (AIH)
2. Donor Insemination

24. • IVF (In vitro fertilization) :- In this, eggs and
sperms are taken from the couple and are
incubated together in a dish in a laboratory to
produce an embryo. Medical specialists place
the embryo into the women’s uterus, where it
may implant and develop succesful pregnancy.

25. • GIFT (Gamete Intra fallopian transfer) :- In this
procedure fertilization occurs naturally after
eggs and sperms are placed inside the
fallopian tube.
• ZIFT (Zygote intra fallopian transfer) :- In ZIFT,
fertilized eggs are transferred to fallopian
tubes within 24 hours after fertilization.

26. • ICSI (Intra cytoplasmic sperm injection:- in this
procedure single sperm is injected into the
mature egg it is used to treat sperm related
infertility problems.
• Surrogate carriers:- A women inseminated
with sperm from male partner of the couple it
is used when the female couple does not
produce healthy eggs that can be fertilized

27. • Gestational carriers:- in this women carrier is
implanted with an embryo that is not
biologically related to her its used when
female couple produces healthy egg but is
unable to carry pregnancy to term.

28. PREVENTION OF INFERTILITY
• Weight management.
• Eat a balanced diet.
• Participating in moderate exercise.
• Making time for leisure and enjoyment.
• Illegal drugs such as marijuana or cocaive should be
avoided.
• Practice safe – sex.
• Keep in mind about the fertility ages of women.

29. THANK YOU