The document discusses infertility, including its definition, causes, risk factors, diagnostic evaluation, management, and prevention. Infertility is defined as the failure to conceive after one year of unprotected intercourse. It can be caused by issues with ovulation, fallopian tubes, or the uterus. Diagnostic evaluations include medical history, exams, and tests of hormones and reproductive organs. Treatments include fertility drugs, surgery, intrauterine insemination (IUI), in vitro fertilization (IVF), and other assisted reproductive technologies (ART). Prevention focuses on maintaining a healthy lifestyle and treating existing diseases early.

1. INFERTILITY
PRESENTED BY:
SUVETHA.G
TUTOR
VMCON

2. DEFINITION:
 Infertility is the failure to conceive (regardless of
the cause) after 1 year of unprotected intercourse.
 Women who are able to get pregnant but then have
repeated miscarriages are also said to be infertile.
 Primary infertility refers to a couple who has never
had a child
 Secondary infertility means that at least one
conception has occurred, but currently the couple
cannot achieve a pregnancy.

3. CAUSES:
 Female infertility usually occurs when there is a problem
with ovulation, a damaged fallopian tube or uterus or a
problem with the cervix.
 Age may also contribute to fertility struggles because as
a woman ages, her fertility decreases.
 Abnormal cervical mucus may be the cause of infertility.
Abnormal cervical mucus may prevent the sperm from
reaching the egg or make it more challenging for the
sperm to penetrate the egg.

4. Ovulation problems may be caused by one or more of
the following :
 A harmone imbalance : Abnormal FSH and LH
secretions
 Anovulation
 Polycystic ovarian syndrome
 A tumor or cyst
 Luteal phase defect
 Premature ovarian failure alcohol or drug abuse
 Thyroid gland problems
 Excess weight
 Stress

5. Damage to the fallopian tubes or uterus may be caused by
one or more of the following :
 Pelvic inflammatory disease
 A previous infection due to chlamydia or gonorrhea
 Polyps in the uterus (fibroids or myomas)
 Endometriosis
 Scar tissues or adhesions
 Chronic medical illness
 A previous Ectopic pregnancy
 Tubal dysfunction
 A congenital defect

6. RISK FACTORS :
 Age
 Stress
 Poor diet
 Athletic training
 Being overweight or underweight
 Tobacco smoking, alcohol
 Sexually transmitted diseases
 Health problems that cause Harmonal changes

7. DIAGNOSTIC EVALUATION :
 Medical history :
Medical history regarding potential factors that could
contribute to infertility
 Physical examination
 Laboratory tests:
-Harmone testing, to measure levels of female
harmones at certain times during a menstural cycle,day
2or 3
-measure of FSH, estrogen and progesterone.

8.  Measurements of thyroid functions :
A thyroid stimulating harmone (TSH)
 Examination and imagining :
-An endometrial biopsy is performed to verify
ovulation and inspect the lining of the uterus
-Hysterosalpingography is done to evaluate size and
contour of uterine cavity and checks whether fallopian
tubes are open.

9.  Pap smear to check for signs of infection
 Special xray tests are also used to diagnose infertility.
Laproscopy is performed which allows doctor to
inspect the pelvic organs to look for
abnormalities or infection.

10. MANAGEMENT:
 The treatment of infertility has made enormous
progress in the last decades as a result of
advances in assisted reproductive technology
 This technology combines the use of fertility drugs,
Harmonal therapy, with artificial insemination
using any one of the technologies:intrauterine
insemination(IUI),in vitro fertilization (IVF),
gamete intrafallopian transfer(GIFT),zygote
intrafallopian transfer (ZIFT) or oocyte (egg)
donation.

11. 1.FERTILITY RESTORATION DRUGS:
 Fertility drugs, forms of harmonal therapy, are
designed to trick the ovaries into producing eggs,
sometimes many eggs in a single cycle,by
stimulating the women’s harmones to do their
assigned jobs more efficiently or by replacing them
with outside harmones.
 Clomiphene citrate(clomid)
 Human menopausal gonadotropin or hMG ( Repronex,
pergonal)

12.  Follicle stimulating harmone or FSH ( Gonal-F,
Follistim)
 gonadotropin-releasing harmone (GnRH) I
analog
 Metformin(Glucophage): This oral drug is used
when insulin resistance is known or suspected
cause of infertility, usually in women with a
diagnosis of PCOS.
Metformin improves insulin resistance,
normalizing the insulin level and making
ovulation more likely to occur

13. 2.FERTILITY RESTORATION SURGERY:
 Tissue removal:
This surgery removes endometrial tissue or pelvic
adhesions with lasers or ablation,which can improve
chances of achieving pregnancy.
 Tubal reversal surgery :
After a women has had her tubes tied for
permanent contraception(tubal ligation), surgery may
be done to reconnect them and restore fertility.

14.  Tubal surgeries:
-If fallopian tubes are blocked or filled with fluid
(hydrosalpinx), tubal surgery may improve chances
of becoming pregnant.
-laproscopic surgery is performed to remove
adhesions, dilate a tube or create a new tubal
opening
- Tubal surgery is more successful when the
blocked or narrowed part of the tube is closer to
the ovary than to the uterus

15. 3.ASSISTED REPRODUCTIVE TECHNOLOGIES :
- Assisted reproductive technologies (ART) is a
term that describes several different methods used
to help infertile couples.
- ART involves removing eggs from a woman’s body,
mixing them with sperm in the laboratory and
putting the embroys back into a women’s body.
Common methods of ART includes:

16.  Intrauterine insemination(IUI):
-In this procedure, a small amount of concentrated
sperm, first washed to remove most of the seminal
plasma that surrounds it, is placed in the uterus
through a thin plastic catheter that is passed through
the vagina and cervix.
-IUI is almost always used in combination with fertility
drug: Clomiphene or Pergnol to stimulate ovulation
followed by an HCG injection to trigger the release of
an egg.

17.  In vitro fertilization (IVF):
-IVF means fertilization outside of the body
-It is often used when a woman’s fallopian tubes are
blocked or when a man produces too few sperm.
-Doctors treat the women with a drug that causes
the ovaries to produce multiple eggs.
-once mature the eggs are removed from the woman .
-They are put in a dish in the lab along with the
man’s sperm for fertilization.
-After 3 to 5 days, healthy embroys are implanted in
the women’s uterus.

18.  Zygote intrafallopian transfer :
-ZIFT or tubal embryo transfer is similar to IVF
- Fertilization occurs in laboratory, then the very
young embryo is transferred to the fallopian tube
instead of the uterus.
 Gamete intrafallopian transfer: ( GIFT)
-GIFT involves transferring eggs and sperm into the
women’s fallopian tube
-so fertilization occurs in the women’s body.

19. PREVENTION:
Some cases of female infertility may be prevented
through identified intervention:
 Maintaining a Helathy lifestyle:
-Excessive exercise, smoking, consumption of
caffeine and alcohol are all associated with
decreased fertility
-Eating a well balanced, nutritious diet, with
plenty of fresh fruits and vegetables(plenty of
folates)and maintaining a normal weight are
associated with better fertility prospects.

20.  Treating or preventing existing diseases :
-Identifying and controlling chronic diseases such
as diabetes and hypothyroidism increases fertility
prospects.
-Obtaining prompt treatment for sexually
transmitted diseases reduces likelihood of infections
that do significant damage
-Regular physical examinations( pap smear) help
to detect early signs of infections or abnormalities

21.  Not delaying parenthood :
- Fertility does not ultimately cease before
menopause
but it starts declining after age 27 and
drops at a somewhat greater rate after age
35.