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Infertility
- 3. Infertility is definedas a failure to conceive within one or more years of regular unprotected coitus.
- 4. It is oftwo types Primary infertility- it denotes those patients who have never conceived. Secondary infertility- it indicates previous pregnancy but failure to conceive subsequently.
- 5. 80% ofcouples 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 tubesshould 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 fourmain 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 beyond35 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 detectthe 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 thebasic investigation should be carried out like Semen analysis Confirmation of the ovulation Confirmation of tubal patency
- 14. It is separatefor 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 Thoroughphysical 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 Itincludes 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 forcouples 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 Drugsand 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 relatedto 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 vitrofertilization (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- Gameteintra-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 (Intracytoplasmicmorphologically 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 daysinfertility 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 discussedabout the infertility, incidence, causes, investigation and treatment modalities and ART.
- 35. A survey ofrelationship 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 was17–45 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 tothese patients psychologically and treating them properly, is of great importance for their mental health and will improve quality of their lives.