GRACIOUS COLLEGE OF NURSING

RAIPUR C.G.

INFERTILITY

PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR
 DEFINITIONS

Infertility is defined as the failure to conceive

after one year of regular intercourse without
contraception.
According to Dr. Kamini A Rao
Infertility is a disease of the male or female
reproductive system defined by the failure to achieve a
pregnancy after 12 months or more of regular
unprotected sexual intercourse.
According to S.S. Randhawa
 TYPES
OF
INFERTILITY
 TYPES OF INFERTILITY

Primary: A woman who was never pregnant

and who can’t conceive after one year of not
using birth control.

Secondary: Secondary infertility occurs when a

woman can’t get pregnant again after having at
least one successful pregnancy.
 Risk factors
Many of the risk factors for both male and
female infertility are the same. They include:
Age.
Tobacco use.
Alcohol use.
Being overweight.
Being underweight.
Exercise issues.
 1. SPERM ABNORMALITY
sperm abnormality are due to low
sperm count ,poor sperm quality
its caused is unknown in 30% to
40% of cases.

Low sperm count ( Oligospermia )

A low sperm count is also called
oligospermia
POOR SPERM MOTILITY –
Slow and zig-zig movement of sperm
may have difficulty invading cervical
mucosa or penetration the zona
pellucida of the egg

Poor sperm motility means that the

sperm do not swim properly, which can
lead to male infertility. Poor sperm
motility is also known
as asthenozoospermia .
ABNORMAL SPERM MORPHOLOGY

Abnormal sperm have head or tail defects —

such as a large or misshapen head or a
crooked or double tail. These defects might
affect the ability of the sperm to reach and
penetrate an egg.

Teratospermia means increase in the

percentage of sperm with abnormal form in
semen.
LOW SEMEN LEVEL –

( below the normal 2.5 -5 ml in one

ejaculation ) may caused infertility
2. OTHER STRUCTURAL ABNORMALITY
@ Anorchia - Anorchia is the absence of
both testes at birth.

@. Testicular Dysgenesis Syndrome –

the genital abnormalities this syndrome
Hypospadias - is a birth defect in boys in
which the opening of the urethra is not
located at the tip of the penis.
@. sperm transport tube block-
Ejaculatory duct obstruction (EDO) refers to a
blockage of the ejaculatory duct (sperm duct)

@ . Syringomyelia - it is a neurological
disorder in which a fluid-filled cyst (syrinx)
forms within the spinal cord. to damage the
spinal cord and compress and injure the nerve
fibers that carry information to and from the
brain to the body. Result problem create in
ejaculate .
 3. GENETIC FACTORS-
@ Defective genetic material

@ Klinefelter syndrome is a genetic condition affecting

males, Klinefelter syndrome may adversely affect testicular
growth, resulting in smaller than normal testicles, which can
lead to lower production of testosterone.

@ kartagener syndrome - The immotility is due to variety

of ultrastructural defects in respiratory cilia and sperm tail.

@ polycystic kidney disease - hormonal deficits associated

with uremia, chronic inflammation, and changes in
reproductive hormone levels.
4. ENVIRONMENTAL AND LIFE STYLE OF
INFERTILITY AND LOW SPERM COUNT

@ Free Radicals ( Oxidants ) –

Although free radicals are naturally produce in
the body as a by product of many metabolic
biochemical's reactions but several
enviormental factors ,chemicals and infections
produce high level of these radicals .high level
of radicals effect the genetic material as well
as the sperm in males
@.Exposed to estrogen like chemicals

Increased in male infertility and testicular ,

prostate cancer estrogen like chemical and
infections found in pesticides and other
industrial chemicals. over exposure to this
chemical reduce of number of sertoli cells
(regulate cholesterol metabolism at the time
of spermatogenesis ) in male
@. Exposure to heavy metals
@. Radiation treatments
@. Smoking
@. Malnutrition and nutritional deficiency –
deficiency of vitamin C and E
@. Abuse of substance
@. Overheating The Testicles - Sperm cells tend
to die when exposed to too much heat. Continuous
exposure to higher temperatures can cause sperm
production to be lower, or cause the production of
abnormally shaped sperm cells resulting in infertility.
@ Emotional stress –
Men who feel stressed are more likely to
experience decreased testosterone, lower
sperm count, abnormal sperm production, and
decreased sperm motility, the function that
allows sperm to move. And all of this can
negatively affect overall fertility.
 INFECTION AND MEDICAL CONDITION
Variocele - varicose vein in scrotum
Hypogonadism – Testosterone deficiency
Sexually transmitted disease – reputed infection of Chlamydia
tracomatis or gonorrhea infection can caused scarring and
blockage of sperm passage area human papllomaviruses may
also impaired sperm function
Mumps - is a viral infectious disease caused due
to mumps virus that affects the male glands of saliva and
testicles, leading to infertility in men.
Other medical condition - severe injury ,HIV , Heart disease
,kidney disease Cushing syndrome ( too much of the hormone
cortisol over a long period of time.) D.M. anemia .
 LACK OF PROPER GROWTH AND
DEVELOPMENT:
Proper growth and development during the
period of puberty and adolescence are
essential for fertility in women. Nutritional
deficiency, especially of the proteins may
cause an underdevelopment of the genital
organs and improper functioning of the
endocrine system. That is why the women
having irregular and scanty periods are often
infertility .
Ovulation disorders
which affect the release of eggs from the ovaries.
These include hormonal disorders such as polycystic
ovary syndrome. Hyperprolactinemia, a condition in
which have too much prolactin — the hormone that
stimulates breast milk production — also may
interfere with ovulation.
Either too much thyroid hormone (hyperthyroidism)
or too little (hypothyroidism) can affect the
menstrual cycle or cause infertility. Other underlying
causes may include too much exercise, eating
disorders or tumors.
 Uterine or cervical abnormalities,
Including abnormalities with the
cervix, polyps in the uterus or the
shape of the uterus. Noncancerous
(benign) tumors in the uterine wall
(uterine fibroids) may cause infertility
by blocking the fallopian tubes or
stopping a fertilized egg from
implanting in the uterus.
 Fallopian tube damage or
blockage
Often caused by inflammation of
the fallopian tube (salpingitis). This
can result from pelvic inflammatory
disease, which is usually caused by a
sexually transmitted infection,
endometriosis or adhesions.
Endometriosis

which occurs when endometrial

tissue grows outside of the
uterus, may affect the function
of the ovaries, uterus and
fallopian tubes.
Pelvic adhesions,
bands of scar tissue that bind
organs that can form after
pelvic infection, appendicitis,
endometriosis or abdominal or
pelvic surgery.
Cancer and its treatment.
Certain cancers — particularly
reproductive cancers — often
impair female fertility. Both
radiation and chemotherapy may
affect fertility.
History taking
Physical examination

Pelvic exam:
Doctors will perform a pelvic exam, including a Pap smear to
check for structural problems or signs of disease.
Blood test: A blood test can check hormone levels, including
thyroid hormones.
Transvaginal ultrasound: Your doctor inserts
an ultrasound wand into the vagina to look for problems with
the reproductive system.
Hysteroscopy: Your provider inserts a thin, lighted
tube (hysteroscope) into the vagina to examine the
uterus.

Saline sonohysterogram (SIS): Your provider fills

the uterus with saline (sterilized salt water) and
conducts a transvaginal ultrasound. A full uterus
makes it easier to see inside the uterus.

Hysterosalpingogram (HSG): X-rays capture an

injectable dye as it travels through the fallopian
tubes. This test looks for blockages.
 Laparoscopy: Your
provider inserts a
laparoscope (thin tube
with a camera) into a
small abdominal
incision. Female pelvic
laparoscopy helps
identify problems like
endometriosis, uterine
fibroids and scar tissue.
 MALE INFERTILITY DIAGNOSED
These tests can help diagnose or rule out a male fertility
problem:
Semen analysis: This test checks for problems with sperm,
such as low sperm count and poor mobility. Some men need
a needle biopsy to remove sperm from the testicles and test
it.
Blood test: A blood test can check testosterone, thyroid and
other hormone levels. Genetic blood tests look for
chromosomal abnormalities.

Scrotal ultrasound: An ultrasound of the scrotum identifies

varicoceles or other testicular problems.
 A narrow, tightly-coiled tube
that is attached
Epididymis A narrow,to tightly-coiled
each of the tube that is attached to
eachtesticles (the male
of the testicles (thesex glands
male sex glands that produce sperm)
that produce sperm)
Polycystic ovary syndrome (PCOS) is a condition in which the
ovaries produce an abnormal amount of androgens,
Medications: Fertility drugs change hormone levels to
stimulate ovulation.
To provide the correct information about the infertility and their
management
In vitro fertilization (IVF) –
During IVF , mature eggs are
collected (retrieved) from ovaries
and fertilized by sperm in a lab.
procedures used to help with
fertility or prevent genetic problems
and assist with the conception of a
child.
Intrauterine insemination (IUI) — a type of artificial insemination — is a
procedure for treating infertility. Introduction of sperm in to female
uterine cavity for achieving pegnacy