Infertility is defined as the inability to conceive after 12 months of unprotected sex. It affects around 15% of couples. Common causes include ovulatory disorders, problems with the uterus or fallopian tubes, low sperm count or quality, cervical issues, and unexplained factors. Diagnosis involves medical histories, physical exams, and lab tests of hormone levels and semen analysis. Treatment depends on the underlying causes but may include medications to stimulate ovulation, surgery to repair organs or reverse sterilization, artificial insemination, in vitro fertilization, or intracytoplasmic sperm injection. The goal is to improve chances of natural conception or support conception in a lab setting.

1. INFERTILITY
Fatima salah osman
MSc of Nursing in Obstetrics and
Gynecology
PhD student in Obstetrics and Gynecology

2. Definition :
Inability of couple to conceive following 12 months of exposure
pregnancy – uninterrupted unprotected sexual intercourse
•Primary :Never got pregnant
•Secondary : got pregnant be fore
Causes:
•30% male
•30% female
•40% male + female

3. Prevalence %
Case Secondary Primary
1.Unexplained 25 20
2.Ovulatory disorders 25 15
3.Tubal disease 20 40
4.Uterine or peritoneal disease 10 5
5.Male factor 30 20

4. • IN WOMEN:-
 Ovulation disorders:-
• Premature ovarian failure(before age of 40)
• Polycystic ovary syndrome
• Poor egg quality
 Problems in uterus &fallopian tubes:
• Surgery
• Sub-mucosal fibroid
• Endometriosis
• Previous sterilization treatment

5. • damage of fallopian tubes can prevent contact
between the ovam and sperm
• pelvic inflammatory diseases (PID) caused by various
infection ,endometriosis ,pelvic surgery lead to damage
to fallopian tubes
• STIs are common cause of PIDs
• Uterus abnormal anatomy of uterus the presence of
polyps and fibroids may lead to infertility

6. Cervical causes a small group of women may
have a cervical condition in which the sperm
cannot pass through the cervical canal due to
abnormal mucus production or prior cervical
procedure

7. Medication :
• NSIDs (aspirin &ibuprofen )
• Chemotherapy
• Radiotherapy
• Illegal drugs

8. • IN MEN:-
Low sperm count :-
• Less than 10 million sperm per mal of semen
• normal count is 20 million sperm per ml of
semen or more
No sperm :-
• Absence of sperm in semen
 low sperm motility
• Sperm are immotile can not swim

9. Abnormal sperm :-
• (unusual shape more difficult to move and
fertilize egg)
• Its causes are:
• Testicular infection
• Testicular cancer
• Testicular surgery
• Overheating testicles
• Ejaculation disorder

10. • Variocele (include varicose vein in scrotum
• Hypogonadism (testosterone deficiency )
• Genetic abnormality
• Mumps( testicular inflammation)

11.  Ageof thewoman
 after 40 the fertility rate decreases by 50% while the
risk of miscarriage increases
 Ageof the man
age affects coital frequency and sexual
 increased
function
 Nutrition
 for women, weight 10% to 15% below normal or
obesity may lead to less frequent ovulation and
reduced fertility

12. • Environmental /occupational factor
• smoking and alcohol

13. DIAGNOSIS OF INFERTILITY
1. History collection.
2. Physical examination: General appearance,
external genitalia.
3. Semen analysis test: Semen volume,
sperm motility, semen culture.
4. Genetic test: Sex chromosome and
somatic mutation.
5. Endocrine test: Serum testosterone,
serum L.H and F.S.H.

14.  Laboratory tests: Measurement of FSH
and progesterone.
 Endometrial biopsy is performed to
verify ovulation.
 Hysterosalpingography
 Pap smear to check for signs of
infection.

15. Investigations
Wife:
1. Follicle stimulating hormone FSH
2. Luteinizing hormone LH
3. Prolactin
4. Thyroid sfimulahins hormone TSH
5. Sometime testosterone
6. Anti mullerian hormone
7. Ultrasound : polycystic ovary syndrome (PCO) , fibroid , pelvic
pathology .
8. Tubal patency
-Hysterosalpingogram HSG
-Laparoscopy

16. Husband :
- Semen analysis
- Who preference values for seminal fluid analysis
- Semen volume ≥ 1.5 ml
- PH ≥ 7.2
- Sperm concentration : ≥ 15million per ml .
- Total sperm number : ≥ 39 million per ejaculate
- Total motility (progressive and non – progressive motility ):
≥ 40% molile or ≥ 32% with progressive motility
- Vitality : ≥ 58% live spermatozoa
- Sperm morphology :≥ 4% normal forms .

17. Treatment For Infertility
treatment of male infertility:-
• The treatment of male partner is indicated in
extreme oligospermia, Azospermia, low volume
ejaculation and Impotency
• Treatment consists of:
• Improvement of general health.
• Avoiding medications.
• Medications to treat specific causes.
• Specific treatment.
• Surgical management.

18. Improve of general health
 Reduction of weight in obese.
 Avoidance of alcohol and heavy
smoking.
 Avoidance of occupation that may
elevate testicular temperature.

19.  Medication that interferes with the
spermatogenesis such as beta
blockers, anti depressant, Cytotoxic
drugs, cimetidine should be avoided
avoided.

20. A. HCG for hypogonadism.
B. Dopamine agonists (Carbergoline) to
improve low libido.
C. Clomophene citrate.
D. Antibiotics for genital tract infection.

21.  Specific treatment includes
Intrauterine insemination( IUI)
 Invitro fertilization( IVF)
 Intracytoplasmic sperm injection(ICSI
).

22. IUI is a procedure in which a catheter
is inserted through the cervix into the
uterus to deposit a sperm sample
directly into the uterus.

24.  IVF is a process by which an egg is
fertilized by sperm outside the body.
In Vitro= In glass.

26.  ICSI is the most successful form of
treatment who are infertile.
 ICSI only requires one sperm which is
injected directly into the egg and
fertilized egg is transferred to uterus.

28.  Vasovasostomy: A Vasovasostomy is a
surgical procedure in which the effects of a
vasectomy are reversed.
 Vasovasostomy creates an opening between
the separated ends of the vas deferens .

29.  Treatment of female infertility consists of
fertility restoration drugs, fertility restoration
surgeries, Assisted reproductive
technologies( ART) .`
 `

30.  To stimulate ovulation. Drugs are:
1. Clomophene citrate.
2. Human menopausal
gonadotrophins.
3. Follicle stimulating hormone.
4. Gonadotrophin releasing hormone .
5. Bromocriptine.

31.  Tissue removal: This surgery removes
endometrial or pelvic adhesions with
lasers or ablation.
 Tubal surgeries: If fallopian tubes are
blocked or filled with fluid , tubal
surgery improve chances of becoming
pregnant.

32.  Laparoscopic surgery is performed to
remove adhesions and create a new
tubal opening.
 Salpingectomy: It can improve
chances of pregnancy with
invitrofertilization.

33.  ART involves removing of eggs from a
woman body and mixing with sperm
in the laboratory.

34. 1. Intrauterine insemination.
2. Invitro fertilization.
3. Zygote intrafallopian transfer( ZIFT) .
4. Gamete intrafallopian transfer( GIFT) .
5. Intracytoplasmic sperm injection( ICSI) .

37.  ZIFT is an ART designed to transfer
the fertilized embryo into the fallopian
tube instead of the uterus.
 Here zygote is place in the fallopian
tube through which it will reach into
the uterus.
 It is similar to IUF.

38.  GIFT involves transferring eggs and
sperm into the women’s fallopian
tubes so fertilization occurs in the
woman’s body.