presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION Dr. Sharda jain Lifecare...Lifecare Centre
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION DR. SHARDA JAIN , DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
DEFINITION
Unexplained infertility means that couple does not conceive after 1year of unprotected vaginal sexual intercourse, with basic infertility evaluation showing no obvious abnormality.
INCIDENCE
15%to 20% of infertile couples
UNEXPLAINED IS PRIMARILY A
DIAGNOSIS OF EXCLUSION
Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples. Infertility may result from an issue with either you or your partner, or a combination of factors that prevent pregnancy.
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION Dr. Sharda jain Lifecare...Lifecare Centre
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION DR. SHARDA JAIN , DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
DEFINITION
Unexplained infertility means that couple does not conceive after 1year of unprotected vaginal sexual intercourse, with basic infertility evaluation showing no obvious abnormality.
INCIDENCE
15%to 20% of infertile couples
UNEXPLAINED IS PRIMARILY A
DIAGNOSIS OF EXCLUSION
Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples. Infertility may result from an issue with either you or your partner, or a combination of factors that prevent pregnancy.
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
Investigations for iufd & sb, how to select?Wafaa Benjamin
Foetal loss is a distressing situation for the lady ,family and medical staff as well.
Investigating the cause of death has many benefits .
Meticulous history taking and clinical assessment is of at most importance.
There are routine standard tests & others arte selective directed by clinical scenarios.
Researches & recording are required to estimate main causes of foetal death at local level, so, investigations could be directed.
In presence of lack of resources, selection of investigations should be prioritized by most relevant and most informative ones.
Post-mortem examination should be re-included at least external examination & placental histopathology.
2.1 DEFINITION OF INFERTILITY :
Infertility is defined as a failure to conceive within one or more year of regular unprotected coitus.
2.2 TYPES OF INFETILITY:
1. PRIMARY INFERTILITY:
SECONDARY INFERTILITY
2.3 CAUSES OF INFERTILITY :
• MALE FACTORS :
DEFECTIVE SPERMATOGENESIS
SECONDARY INFERTILITY
2.3 CAUSES OF INFERTILITY :
• MALE FACTORS :
DEFECTIVE SPERMATOGENESIS
Infection
Gonadotropin suppression
Endocrine factors
Immunological factors
Tubal and peritoneal factors
UTERINE FACTORS CERVICAL FACTORS
VAGINAL FACTORS
COMBINED FACTORS
DIAGNOSTIC PROCEDURES
FOR FEMALE
HISTORY
EXAMINATIONS
DIAGNOSTIC EVALUATION:
1. CERVICAL MUCUS STUDY
2. HORMONAL ESTIMATION
3. ENDOMETRIAL BIOPSY
4. SONOGRAPHY
5. LAPROSCOPY
6. INSUFFLATION TEST (Rubin’s test)
2.5 RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT :
ASSISTED REPRODUCTIVE TECHNIQUES (ART)
“ASSISTED REPRODUCTIVE TECHNIQUES INVOLVING DIRECT RETRIEVAL OF OOCYTE FROM OVARY, MANIPULATION OF GAMETS AND EMBROYOS OUTSIDE BODY FOR PURPOSE OF ESTABLISHING PREGNANCY”.
TYPES OF ART :
1. IUI (Intrauterine insemination)
2. IVF-ET(In vitro fertilization & embryo transfer)
3. ZIFT(Zygote intra fallopian transfer)
4. ICSI (Intra cytoplasmic sperm injection) (TESA, PESA, MESA)
5. EMBRYO OR OOCYTE DONATION
6. GESTATIONAL CARRIER
7. SURROGACY
2.6 ROLE OF NURSE IN MANAGEMENT OF
INFERTILITY :
] ASSESSMENT :
- Assessment of the infertile couple is the initial stage of infertility management. The nurse is often the first contact the infertile couple make during their visit for treatment. The nurses role during this stage is to educate the couple about each test or investigation. The nurse plays a vital role in alleviating the fear and anxiety about the various diagnostic procedure.
2] TREATMENT :
- The nurse plays the link between the doctor and the couple and should always be available to the couple for their assistance, guidance and support before, during and after the infertility treatment.
- Numerous ethical issues are associated with infertility treatments and the couple undergoing treatment need appropriate counselling and discussion.
-The goal of the nurse helping the infertile couple is to assist them through the treatment cycle as smoothly as possible.
3] EDUCATION :
- The role of a nurse in educating the patients includes education about the basic male and female anatomy and physiology and how the drugs act on their body, including possible side effects. This may be offered under various setting such as
• Face to face on an individual basis.
• In a group situation,
• Fertility nurses should also educate the couple about the self-administer medications.
• Proper knowledge of administration of these medicines and storage conditions for medications, as well as the possible side affects, should be imparted to the couple undergoing treatment.
4] PSYCHOLOGICAL SUPPORT :
-A couple undergoing infertility treatments are usually under stress due to variety of reasons.
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
Investigations for iufd & sb, how to select?Wafaa Benjamin
Foetal loss is a distressing situation for the lady ,family and medical staff as well.
Investigating the cause of death has many benefits .
Meticulous history taking and clinical assessment is of at most importance.
There are routine standard tests & others arte selective directed by clinical scenarios.
Researches & recording are required to estimate main causes of foetal death at local level, so, investigations could be directed.
In presence of lack of resources, selection of investigations should be prioritized by most relevant and most informative ones.
Post-mortem examination should be re-included at least external examination & placental histopathology.
2.1 DEFINITION OF INFERTILITY :
Infertility is defined as a failure to conceive within one or more year of regular unprotected coitus.
2.2 TYPES OF INFETILITY:
1. PRIMARY INFERTILITY:
SECONDARY INFERTILITY
2.3 CAUSES OF INFERTILITY :
• MALE FACTORS :
DEFECTIVE SPERMATOGENESIS
SECONDARY INFERTILITY
2.3 CAUSES OF INFERTILITY :
• MALE FACTORS :
DEFECTIVE SPERMATOGENESIS
Infection
Gonadotropin suppression
Endocrine factors
Immunological factors
Tubal and peritoneal factors
UTERINE FACTORS CERVICAL FACTORS
VAGINAL FACTORS
COMBINED FACTORS
DIAGNOSTIC PROCEDURES
FOR FEMALE
HISTORY
EXAMINATIONS
DIAGNOSTIC EVALUATION:
1. CERVICAL MUCUS STUDY
2. HORMONAL ESTIMATION
3. ENDOMETRIAL BIOPSY
4. SONOGRAPHY
5. LAPROSCOPY
6. INSUFFLATION TEST (Rubin’s test)
2.5 RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT :
ASSISTED REPRODUCTIVE TECHNIQUES (ART)
“ASSISTED REPRODUCTIVE TECHNIQUES INVOLVING DIRECT RETRIEVAL OF OOCYTE FROM OVARY, MANIPULATION OF GAMETS AND EMBROYOS OUTSIDE BODY FOR PURPOSE OF ESTABLISHING PREGNANCY”.
TYPES OF ART :
1. IUI (Intrauterine insemination)
2. IVF-ET(In vitro fertilization & embryo transfer)
3. ZIFT(Zygote intra fallopian transfer)
4. ICSI (Intra cytoplasmic sperm injection) (TESA, PESA, MESA)
5. EMBRYO OR OOCYTE DONATION
6. GESTATIONAL CARRIER
7. SURROGACY
2.6 ROLE OF NURSE IN MANAGEMENT OF
INFERTILITY :
] ASSESSMENT :
- Assessment of the infertile couple is the initial stage of infertility management. The nurse is often the first contact the infertile couple make during their visit for treatment. The nurses role during this stage is to educate the couple about each test or investigation. The nurse plays a vital role in alleviating the fear and anxiety about the various diagnostic procedure.
2] TREATMENT :
- The nurse plays the link between the doctor and the couple and should always be available to the couple for their assistance, guidance and support before, during and after the infertility treatment.
- Numerous ethical issues are associated with infertility treatments and the couple undergoing treatment need appropriate counselling and discussion.
-The goal of the nurse helping the infertile couple is to assist them through the treatment cycle as smoothly as possible.
3] EDUCATION :
- The role of a nurse in educating the patients includes education about the basic male and female anatomy and physiology and how the drugs act on their body, including possible side effects. This may be offered under various setting such as
• Face to face on an individual basis.
• In a group situation,
• Fertility nurses should also educate the couple about the self-administer medications.
• Proper knowledge of administration of these medicines and storage conditions for medications, as well as the possible side affects, should be imparted to the couple undergoing treatment.
4] PSYCHOLOGICAL SUPPORT :
-A couple undergoing infertility treatments are usually under stress due to variety of reasons.
Robert Oates, M.D. - Microsurgical Epididymal Sperm Aspirationhooksheather
Microsurgical Epididymal Sperm Aspiration (MESA) is performed when there is a blockage to sperm flow that cannot be corrected.
Having one of the world’s largest experiences in this procedure, I extract sperm from outside the testis, freeze it at one of the many IVF groups I work with, and they use it later as a source of sperm for a cycle of ICSI. The pregnancy rate is excellent. I authored the first papers on intentionally freezing the sperm, now a commonly used approach in the top IVF centers.
Threatened abortion by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Threatened abortion is associated with bleeding and/or uterine cramping while the cervix is closed. This stage of abortion may progress to spontaneous incomplete or complete abortion. While this event may be considered a part of the quality control process in human reproduction, it is important to know the possible etiologies and when therapy might prevent pregnancy loss. The World Health Organization estimated that 15% of all clinically recognizable pregnancies and in spontaneous abortion, 50-60% of which are due to chromosomal abnormalities. Apart from the fetal factors, several maternal and probably paternal factors contribute to the causes of spontaneous abortion. The maternal factors that may be responsible for abortion include both local and systemic conditions such as infections, maternal disease states, genital tract abnormalities, endocrine factors and other miscellaneous causes (antiphospholipid antibodies, maternal-fetal histocompatibility, excessive smoking and other environmental toxicants, etc.). This review focuses on the management of threatened abortion, but it should be emphasized that the management to maintain pregnancy is reasonable only in those cases, in which the fetus is not seriously affected. It would not be beneficial to provide treatment that would permit chromosomally and anatomically abnormal embryos to survive to term. Treatment is feasible first of all in cases with maternal factors. Surgical procedures may precede pregnancy (correction of septate uterus, removal of a submucous leiomyomata) or may be performed usually in the second trimester (cervical cerclage). Maternal general diseases (diabetes, hypothyroidism) and infections should be treated accordingly. The most common entity to be treated in this category is luteal phase deficiency. Progesterone is the most important hormone for the maintenance of an early human pregnancy. Besides progesterone administration, human chorionic gonadotropin (hCG) also is the logical endocrine treatment of choice. In the pregnant woman hCG stimulates and optimizes hormonal production in the corpus luteum and may also influence the fetoplacental unit. The contribution of environmental, physical and chemical agents to the incidence of spontaneous abortion is controversial. They may be abortifacient even if they are not teratogenic. Exposure to environmental toxicants should be avoided. Paternal leukocyte immunotherapy has been associated with successful outcome in patients with unexplained repeated spontaneous abortion. This therapeutic approach is considered experimental, as there may be some significant risks. Associating maternal antiphospholipid antibodies with reproductive failure is a rapidly developing field. Administration of corticosteroids with low doses of aspirin has resulted in fetal salvage in women in whom antiphospholipid antibodies are present.
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
Male and female infertility, being a common problem needs one to better understand it! Know how infertility is causes and how it is cured with fertility treatments and solutions! IVF (test tube baby) and assisted reproductive techniques!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
3. Introduction.
Definition:
Infertility is the inability to achieve and sustain a
pregnancy to delivery after at least 1 year of regular
unprotected ejaculatory vaginal sexual intercourse
with an adult of the opposite sex.
• Subfertility - a special case of infertility when there
are deliveries but not having any or desired number
of children alive.
4. Introduction cont.
• Infertility is a world wide problem affecting (5-20%) of
couple.
• In Africa, infertility is often overshadowed by a high
fertility rate and population density.
• African is the poorest of the continents with low capacity
and technologies to handle these two problems.
5. Prevalence of infertility.
• Infertility may be primary or secondary.
• Primary infertility occurs when the couple has not
achieved any pregnancy.
• Secondary infertility occurs in a couple who have had
at least a pregnancy irrespective of the outcome.
6. Prevalence cont.
Clinic based studies:
• In our environment, 20-30% is primary while 70-
80%of cases is secondary.
• In the developed countries primary is 80% as against
secondary of 20%.
• Population based studies suggest that secondary
infertility is more than primary infertility worldwide.
7. Prevalence cont.
• This reflect marked differences in the causative factors.
• Voluntary infertility often masks involuntary infertility in
developed countries.
• Desire for a large family size increases the burden of
infertility in developing countries.
• In Africa, the prevalence of infertility tend to follow the
pattern of pelvic infections.
9. Trend in the prevalence of infertility
• There is an overall increase in prevalence of infertility
in the last 3 decades compared to 3 decades before
that.
• Increase is prominent amongst the blacks, rising
from 3% to 13%
• This coincides with a rise in the prevalence of STD
and ectopic pregnancy.
• Amongst the whites the prevalence od infertility
caused by STI is about 0.7% -1%
10. Factors affecting fertility.
• Age:
9-16years – due to irregularity of menstrual
cycle. Desire to achieve a vocation.
Age > 35 years – reduction in ovulation
potential. Increased risk of chromosomal
abnormalities.
11. Factors affecting fertility cont.
• Social / Nutritional status / Income.
• Education – educated women tend to delay
conception.
• Marital status.
• Occupation – Foundry workers, agriculturists.
• Exposure to environmental toxicants eg benzene,
heavy metals.
• Fertility rate has dropped by 3% worldwide due to
uncertain factors.
12. Gender distribution of infertility
• The problems of infertility is often born by the
woman.
• Men are responsible for 33.3 % of infertility
cases.
• Women contribute to only about 25% of
cases.
• Both male and female factors for 20% and in
15% of cases not detectable. (WHO, 1992)
13. Causes of infertility
• 85 to 90% of couples or individuals who experience
infertility have a diagnosis for their infertility.
• In about 3% - 6% of couples the underlying causes of
infertility are not known.
• Causes vary with area and development.
14. Causes of infertility: Female factors.
1) Tuber disease like blockage and adhesion.
2) Anovulation - Regular
- Oligo-ammenorrhae
- Secondary “
- Primary “
- High prolactin level
19. Female factors cont.
Uterine factors
• Fibroids at the corpus or cervix
• Endometriosis
• Uterine Synaechae
• Cervical incompetence.
• Cervical hostility.
• Aplasia / dysplasia.
Vaginal factors:- gynaetresia
20. Male factors
• Testicular varicose
• Genital infections
• Mumps orchitis.
• Previous groin/scrotal surgery
• Heavy smoking/chronic alcohol intake
• Chronic and serious systemic illness
• Men currently on fertility drugs or steroid
preparations.
21. Infertility – Lifestyle
• Weight.
Overweight BMI greater than 25
Obese BMI greater than 30
Underweight BMI less than 17
• Smoking
• Cocaine / Marijuana Use
• Alcohol Consumption
22. Evaluation of Infertility.
Normal Reproductive Efficiency.
Time required for conception in couples who will attain
Pregnancy.
Time of Exposure % Pregnant
3months 57%
6months 72%
1 year 85%
2years 93%
Guttmacher AF 1956.
Factors affecting normal expectancy of conception J.A.M.A. 161: 855,
23. Evaluation of Infertility.
History 1
• Gravidity, parity, pregnancy outcome and
associated complications
• Cycle length, and characteristics , onset and
severity of dysmenorrhoea
• Coital frequency and any sexual dysfunction
• Duration of infertility and results of any previous
evaluation and treatment.
• Past Surgery, its indications and outcome and
past or current medical illnesses, to exclude
episodes of PID or exposure to STI.
24. Evaluation of Infertility
History 2.
• Previous abnormal Pap smears and any
subsequent treatment.
• Current medications and allergies.
• Occupation and use of Tobacco, Alcohol, and
other drugs.
• Family history of birth defects, mental
retardation, early menopause or reproductive
failure.
• Symptoms of thyroid disease, pelvic or abdominal
pain, galactorrhoea, hirsutism, and dyspareunia
25. Evaluation of Infertility
Physical Examination.
• Weight and body mass index
• Any thyroid enlargement, nodule or tenderness.
• Breast secretions and their character.
• Signs of androgen excess
• Pelvic or abdominal tenderness, organ
enlargement or mass.
• Vaginal or cervical abnormality, nodularity in the
adnexa or cul-de-sac.
26. INVESTIGATIONS
• The male partner should normally have two
semen analyses performed during the initial
investigation.
• Laboratories that perform semen analysis
should undertake this according to recognised
WHO methodology.
• Laboratories should also practice internal
quality control and belong to an external
quality control scheme .
27. INVESTIGATIONS
• While regular menstruation is strongly suggestive of
ovulation, this should be confirmed by the
measurement of serum progesterone in the mid-
luteal phase
• There is no value in measuring thyroid function or
prolactin in women with a regular menstrual cycle, in
the absence of galactorrhoea or symptoms of thyroid
disease
28. INVESTIGATIONS
• Early follicular phase estimation of FSH and LH
is only performed if clinically indicated
• The female partner should normally have a
test of tubal patency during the initial
investigation of infertility
29. INVESTIGATIONS
• A hysterosalpingogram may be used as a
screening test for tubal patency in low risk
couples
• When an evaluation of the pelvis is required,
however, a diagnostic laparoscopy with dye
transit is the procedure of choice
31. MANAGEMENT
The management of infertility should take
place in a dedicated infertility clinic staffed
by an appropriately trained professional
team with facilities for investigating and
managing problems in both partners.
32. MANAGEMENT
• Both partners should be seen together
• Privacy and sufficient clinical time
• Classical history taking with emphasis on
exploring a couple’s anxieties
• Counseling is very important and essential
• Routine examination is not necessary unless
indicated by the history
33. GENERAL ADVICE TO THE COUPLE
• Sexual intercourse every 2-3 days
• Timed intercourse to coincide with ovulation
causes stress and not to be recommended
• Smoking reduces both, women’s fertility as
well as semen quality
• Excessive alcohol is detrimental to semen
quality and may cause erectile dysfunction
34. GENERAL ADVICE TO THE COUPLE
• A body mass index of more than 29 is
associated with reduced fertility in both men
and women
• Folic acid supplement prior to conception and
up to 12 weeks of conception
• Rubella immunity should be checked
• If vaccinated then advise to avoid pregnancy
for at least one month after vaccination
35. UNEXPLAINED INFERTILITY
• Unexplained infertility is a diagnosis of
exclusion
• Spontaneous pregnancy rate are high in first
three years of trying
• Clomiphene encourages multifollicular
ovulation and increases the chances of
pregnancy in couple’s with unexplained
infertility
36. ASSISTED REPRODUCTION
• These techniques have revolutionized the
management of infertile couples
• Entry guidelines should be followed
• The women should be less than 40 years old
and in good health
• The couple should be aware of the emotional
and financial strain
37. ASSISTED REPRODUCTION
• The most common techniques used are:
Intrauterine Insemination
In-vitro fertilisation
Intracytoplasmic sperm injection
• The success rate of the clinic should be told to the
patient
• The take home baby rate is roughly around 20%
• There is no increase in the incidence of the
congenital abnormalities
38. Bad habits to break to increase fertility
• Staying up late
• Too many cups of coffee
• Over or under exercise
• Over eating and junk food binges
• Procastination
• Drinking too much alcohol
• Smoking
• Unsafe sex
41. PREVENTION OF INFERTILITY
• Effective Health care delivery system
• Wide spread accessible and affordable family
planning.
• Drugs and methods to treat pregnancy
complications and miscarriages.
42. PREVENTION CONT
• Public enlightenment on sex education and
sexual responsibility.
• Adequate prevention and treatment of pelvic
infections
Appropriate counseling on the dangers of late
marriages and post postpoment of child bearing
till the thirds decade of life.
43. Myths about Infertility.
• My periods are dark
• My uterus is tilted backwards
• All sperm run out after intercourse
• Need to lie on my stomach after sex
• Not having periods is bad for the body
• Having sex too often weakens the sperm
• Infertile men are weaklings