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Lect 34 Unit IV Infertility.ppt ahn 1..
- 1. 1 Sub: AHN-I Unit: IVReproductive Disorders Topic: Topic: Infertility Lect: Lect: 34 By By Asif Ali Magsi Asif Ali Magsi
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- 3. Definitions & Terminology •Fertility: the capacity to reproduce or the state of being fertile. • Fecundability: the probability of achieving a pregnancy each month. • Fecundity: the ability to achieve a live birth within 1 menstrual cycle. 3
- 4. Requirements for Conception •Production of healthy egg and sperm • Unblocked tubes that allow sperm to reach the egg. • The sperms ability to penetrate and fertilize the egg. • Implantation of the embryo into the uterus • Finally a healthy pregnancy 4
- 5. Definitions • Infertility: Awoman under 35 has not conceived after 12 months of contraceptive-free intercourse. • Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the World Health Organization. • A woman over 35 has not conceived after 6 months of contraceptive-free sexual intercourse. • Men and women equally affected 5
- 6. Types of Infertility •Primary Infertility – A couple that has never conceived despite of unprotected sex for 12 months • Secondary Infertility – Infertility that occurs after previous pregnancy regardless of outcome 6
- 7. Causes of infertilityin Female • Eating disorders Eating disorders • Ovulation problems • Premature ovarian failure • Tubal blockage • Uterine problems • Endometriosis • Surgery • Previous sterilization treatment Previous sterilization treatment • Previous tubal ligation Previous tubal ligation • Over-exercising Over-exercising (may cause (may cause ovulation problems) ovulation problems) • PCOS (polycystic ovary syndrome) • Submucosal fibroids • Past infections • Structural Problem • Poor sperm motility and/or count 7
- 8. Causes of infertilityin Male • Age Age • Semen Semen • Low sperm count Low sperm count • No sperm No sperm • Low sperm mobility Low sperm mobility • Abnormal sperm Abnormal sperm • Testicular infection Testicular infection • Testicular cancer Testicular cancer • Testicular surgery Testicular surgery • Overheating the testicles Overheating the testicles • Ejaculation disorders Ejaculation disorders • Varicocele Varicocele ( (varicose vein in varicose vein in the scrotum ) the scrotum ) • Undescended testicle Undescended testicle • Hypogonadism Hypogonadism ( (testosterone testosterone deficiency can result in a deficiency can result in a disorder of the testicles disorder of the testicles 8
- 9. Causes Of InfertilityIn Either Sex • Age: Age: (a woman's fertility starts to drop after she is about 32 (a woman's fertility starts to drop after she is about 32 years old, and continues doing so. A 50-year-old man is years old, and continues doing so. A 50-year-old man is usually less fertile than a man in his 20s (male fertility usually less fertile than a man in his 20s (male fertility progressively drops after the age of 40) progressively drops after the age of 40) • Smoking: Smoking: (smoking significantly increases the risk of (smoking significantly increases the risk of infertility in both men and women infertility in both men and women • Alcohol consumption: Alcohol consumption: ( (a woman's pregnancy can be a woman's pregnancy can be seriously affected alcohol consumption. Alcohol abuse may seriously affected alcohol consumption. Alcohol abuse may lower male fertility. lower male fertility. • Not exercising: Not exercising: (leading a sedentary lifestyle is sometimes (leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women. linked to lower fertility in both men and women. 9
- 10. Cont… • Being obeseor overweight: Being obese or overweight: (overweight/obesity and a (overweight/obesity and a sedentary lifestyle are often found to be the principal sedentary lifestyle are often found to be the principal causes of female infertility and higher risk for man causes of female infertility and higher risk for man having abnormal sperm. having abnormal sperm. • Sexually transmitted infections: Sexually transmitted infections: (Chlamydia can (Chlamydia can damage the fallopian tubes, as well as making the man's damage the fallopian tubes, as well as making the man's scrotum become inflamed) scrotum become inflamed) • Exposure to some chemicals: Exposure to some chemicals: ( (some pesticides, some pesticides, herbicides, metals (lead) and solvents have been linked herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women) to fertility problems in both men and women) 10
- 11. Cont… • Stress: Stress: (femaleovulation and sperm production (female ovulation and sperm production may be affected by mental stress) may be affected by mental stress) • General factors: General factors: ( (Diabetes mellitus, thyroid Diabetes mellitus, thyroid disorders, adrenal disease) disorders, adrenal disease) • Medications Medications (e.g. NSAIDs, (e.g. NSAIDs, Chemotherapy, Chemotherapy, Illegal drugs (cocaine) Illegal drugs (cocaine) • Radiotherapy Radiotherapy • Genetic factors Genetic factors 11
- 12. Sign & Symptoms •Inability to achieve conception. Diagnostic Tests for Males • General physical exam • Semen analysis • Blood test (including the man's level of testosterone and other male hormones) • Ultrasound test • Chlamydia test 12
- 13. Diagnostic Tests forFemales • General physical exam • Blood test (hormone levels) • Hysterosalpingography • Laparoscopy 13 • Ovarian reserve testing • Genetic testing • Pelvic ultrasound • Chlamydia test • Thyroid function test
- 14. Treatment of Infertility Treatmentof Infertility • Treatment of infertility depends on the cause, diagnosis, duration of infertility, age of the partners and many personal preferences. • Some causes of infertility cannot be corrected. • A woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility 14
- 15. Cont Cont… … • Artificial Insemination: ArtificialInsemination: deposing semen into he deposing semen into he female genital tract by artificial means is called female genital tract by artificial means is called artificial insemination. artificial insemination. • Insemination with donor: Insemination with donor: when the sperm of the when the sperm of the women’s partner is defective or absent or when women’s partner is defective or absent or when there is a risk of transmitting a genetic disease, there is a risk of transmitting a genetic disease, donor sperm may be used. donor sperm may be used. • In Vitro Fertilization: In Vitro Fertilization: In vitro fertilization In vitro fertilization involves ovarian stimulation, age retrieval, involves ovarian stimulation, age retrieval, fertilization, and embryo transfer fertilization, and embryo transfer. . 15
- 16. Treatment for Men •General sexual problems: General sexual problems: Addressing impotence Addressing impotence or premature ejaculation can improve fertility. or premature ejaculation can improve fertility. • Treatment for these problems often is with Treatment for these problems often is with medication or behavioral approaches. medication or behavioral approaches. • Lack of sperm: Lack of sperm: surgery or hormones to correct surgery or hormones to correct the problem or use of assisted reproductive the problem or use of assisted reproductive technology is sometimes possible. technology is sometimes possible. • Varicocele: Varicocele: can often be surgically corrected. can often be surgically corrected. 16
- 17. Treatment for Women •Stimulating ovulation with fertility drugs: • Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. • These medications regulate or induce ovulation, and work like natural hormones to trigger ovulation such as: Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). 17
- 18. Fertility Drugs &TheRisk of Multiple Pregnancies • Injectable fertility drugs increase the chance of multiple births. • Oral fertility drugs (Clomid) increase the chance of multiple births but at a much lower rate. • The use of these drugs requires careful monitoring. • The greater the number of fetuses, the higher the risk of premature labor. 18
- 19. • Babies bornprematurely are at increased risk of health and developmental problems. • These risks are greater for triplets than for twins or single pregnancies. • The greater the number of fetuses, the higher the risk of premature labor. Cont….. 19
- 20. Surgery • Depending onthe cause, surgery may be a treatment option for infertility. • Blockages or other problems in the fallopian tubes can often be surgically repaired. • Laparoscopic techniques allow delicate operations on the fallopian tubes. • Infertility due to endometriosis often is difficult to treat. 20
- 21. Complications Of InfertilityTreatment • Ovarian hyperstimulation syndrome (OHSS) Ovarian hyperstimulation syndrome (OHSS) (The (The ovaries produce too many follicles ovaries produce too many follicles • Ectopic pregnancy Ectopic pregnancy • Coping mentally Coping mentally ( (As it is impossible to know how As it is impossible to know how long treatment will go on for and how successful it will long treatment will go on for and how successful it will be, coping and persevering can be stressful) be, coping and persevering can be stressful) 21
- 22. Prevention Some strategies suggestedor proposed for avoiding male infertility include the following: •Avoiding smoking as it damages sperm DNA •Avoiding heavy marijuna and alcohol use. •Avoiding excessive heat to the testes. 22
- 23. Nursing Management • Assistin reducing stress in the relationship. • Encourage cooperation • Protect privacy • Foster understanding • Refer the couple to appropriate resources. • Smoking is strongly discouraged • Provide health education on diet, exercise ,stress reduction techniques, health maintainance and disease prevention (Smeletzer & Bera, 2004) (Smeletzer & Bera, 2004) 23
- 24. References • Smeltzer. S.C., Bare. B.G., Hinkle. J. L & Cheever. K. H. Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever. K. H. (2011). (2011). Textbook of Medical – Surgical Nursing. Vol -I Textbook of Medical – Surgical Nursing. Vol -I (12 (12th th Ed.). Wolters Kluwer. New Delhi. Ed.). Wolters Kluwer. New Delhi. • DiGiulio. M., Jackson. D. & Keogh.J. (2007). Medical- Surgical Nursing Demystified- A self Teaching Guide. McGraw-Hill. Toronto. 24
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