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INTRODUCTION
The medical definition of infertility is the failure to
achieve a clinical pregnancy after twelve month or
more of regular unprotected sexual intercourse
(zegers-hochschild; et al 2009).

It is estimated that there are 60- 80 million infertile

couple world wide out of 3 - 6 million are in Nigeria
alone. (Thomas 1995).
INTRODUCTION CONT
 Infertility is a crisis of the deepest kind. Not
everyone has the goal of becoming a parent,
but for those who do, being unable to conceive
a child is exquisitely a painful reality.

 It threatens many aspects of a couple’s life -

not only the partners relationship to each
other, but it also effects them individually and
their relationship with friends and family.
TYPE OF INFERTILITY
 Primary infertility

 Secondary infertility
CAUSES OF INFERTILITY
 The causes of infertility can be classified as:
 Male factor
 Female factor
 Combined male and female factor
 Unexplained factor
THE INFERTILITY TEAMS
 Gynecology

 Embryology

 Psychology

 IVF Nurse

 Client
ROLE OF THE IVF NURSE

 This multidimensional nursing role can be

discussed under the following:
 Advocacy
 Liaison
 Confidant
 Counselling
 Educator
CHARACTERISTICS OF AN IVF NURSE

Knowledge
Intelligence And
Smartness
Confidentiality

Compassion

Composure/Decorum

Patience
THE IVF DOCTOR AND IVF NURSE

The nurse must be able to assist with

scans, procedures and any other work
assigned her.

The IVF doctor sees the clients, request for

investigations and plans treatment. All
these are communicated to the bright IVF
nurse who helps client understand her
treatment.
THE EMBRYOLOGIST AND THE IVF
NURSE

The embryologist need to be aware in good

time of clients who are for procedure or who
have special needs which are within their
jurisdiction.

All sample bottles must be well labelled

before taken to the lab accompanied by the
SFA form.
THE EMBRYOLOGIST AND THE IVF
NURSE CONT.

All information and lab investigations must be

well documented and inside the file
respectively.

The team members of the IVF unit must work in

harmony in the interest of the client.
THE NURSE AND CLIENT

Couples experiencing infertility seek many

different types of treatments. This increases
the opportunity for nurses to encounter these
patients, making it crucial for nurses to be
prepared to address their physical and
emotional needs.
THE NURSE AND CLIENT CONT.

A. PREPARATORY PHASE

 History taking

 Give detailed explanation of the treatment.

 Clear any doubt the client may have .

 Know your limitation, refer clients to relevant team as the need

arises

 Help the couple understand treatment plan.

 refer to accountant as regards cost and payment.

THE NURSE AND CLIENT CONT.

PREPARATORY PHASE CONT.

 Give client treatment itinery e.g. Date of commencement,

possible date of OCR and ET

 Ensure that all lab investigations have been carried out.

 Counselling

 Assess couple (Level of understanding)

 All consent forms must be given, signed and returned.

THE NURSE AND CLIENT CONT.

B. INTRA
 Guide the patient through the treatment plan.
 Documentation.
 Educate the client on medication use (Self
administration of subcutaneous injection).
THE NURSE AND CLIENT CONT.

 INTRA CONT.

 Explain in detail the outcome of scans and

blood tests.

 Allay her fear and anxiety.

 Give her all the support required (emotional

and psychological)
THE NURSE AND CLIENT CONT.

INTRA CONT.

 Instructions must be clearly stated and

understood by client.

 Maintain safety in theatre.

 Expertise required during procedures.

 Ensure client is fully awake before giving post

OCR instructions
THE NURSE AND CLIENT CONT.

INTRA CONT.

 Post OCR patients must not be left

alone until full recovery.

 Post ET instruction must be clearly

stated.

 Be optimistic even though truthful in all

aspects

 Counselling.
THE NURSE AND CLIENT CONT.

POST
• Give accurate information on the dos and
don'ts post procedure.
 Ensure that summary of treatment is given.
 Counselling.
 Guide the woman through grief that follows
unsuccessful treatment.
 Recognition of hidden grief.
 Client follow-up.
TREATMENTS OF INFERTILITY
A.R.T Approach
 IUI (Intra uterine insemination)
 ICSI (Intracytoplasmic injection)
 IVF (In-vitro fertilisation)
 GIFT ( Gaments intrafallopian transfer)
 ZIFT (Zygote intrafalopian transfer)
 IUI
(INTRAUTERINE INSEMINATION )
The placement of sperm in the uterus for the
purpose of enhancing the chance for
pregnancy. Also known as intrauterine
insemination, artificial insemination, IUI,
human intrauterine insemination, artificial
insemination by husband, AIH.
IUI Procedure
Timing of IUI
Timing is more important for IUI than it is for
intercourse. The reason is that, during intercourse,
sperm travels through the cervical canal. There are
glands and mucous in the cervix that sustains the
sperm and acts as a reservoir that releases sperm
into the uterus slowly over several days.
During an intrauterine insemination, the sperm are
released into the uterus. The sperm do not remain
viable for as long a period of time. Consequently, the
sperm must be inseminated close to the time of
ovulation.
Timing cont…..
 One method to time an IUI is with an ovulation predictor
kit. The kit measure a woman’s LH surge. The surge
peaks about 12-24 hours before the egg is released. A
woman will test her urine in the morning. If the test is
positive, she would have the intrauterine insemination
the next day.
 Another method for timing an insemination is to
artificially trigger ovulation. A medication called hCG
can be injected by a woman when ultrasound
determines that the egg or eggs developing in her
ovaries are mature enough to be released. Ovulation
will occur approximately 36 hours later. The hCG trigger
injection is given in the evening and the IUI can be
performed two mornings later.
SPERM COLLECTION FOR IUI

 It is not necessary to abstain from intercourse

before doing an IUI. Sperm counts vary in all men.
The frequency of ejaculation does not have any
consistent effect on sperm numbers. Sometimes
there will be more sperm on a second or third
ejaculate and sometimes there will be less sperm.
 Our recommendation is to have intercourse on the
day that an ovulation kit turns positive or on the
day that an hCG trigger injection is given. The IUI
is then timed as indicated above.
SPERM WASH FOR IUI
 Ejaculation composed two main components:
seminal fluid and sperm. Seminal fluid
contains hormones and chemicals. one group
of chemical prostaglandins cause problems.

 Semen collected is mixed with sperm wash

media, spin by centrifuge and separate
seminal fluid from sperm
SEMEN WASH PREPARATION
IUI PROCEDURE
BEGINNING OF IVF
Follicular Tracking
 Serial scans on day 6, 8, 10,11, 12 of
stimulation.
 Measure all the follicles in each ovary.
 Depending on the number of follicles, either
increase or decrease the dose of
gonadotropins.
 Trigger with HCG when al least 3 follicles
are of size 18mm or more.
 Serum E2 levels are also done at each scan.
 Equipment
 Ultrasound machine: With a vaginal
transducer of 5 MHz with a resolution of
0.5mm & a focal range of 10-60mm from the
tip of the probe.
 Needle: Cook’s single lumen, 17 gauge with
35cm length with sharp tip and total
aspiration lumen volume of 1.00ml.
 Suction Apparatus: With 100mm of Hg
negative pressure.
 Tubes to collect Follicular fluid.
OCR needle
Vaginal probe
Probe with Needle
Technique
 Lithotomy position
 Vagina / Cervix cleaned with normal saline.
 A sterile vaginal probe with needle guide is
introduced in the vagina.
 Pelvis is scanned
 Follicles are visualised.
 Needle is introduced into the follicle
 Follicular fluid is aspirated.
 Flushing of the folllicles in order to increase
the number of oocytes retrieved is
debatable.
 It is done with a double lumen needle with
heparinised saline or heparinised culture
media.
 Follicular fluid is collected in the tubes and
then checked by the embryologists for
presence of eggs.
 All the folllicles are aspirated.
 Post OCR prophylactic antibiotics are given.
EGG COLLECTION
IVF TRANSFER
Technique
 The outer sheath of the catheter is inserted just
beyond the internal os.
 The embryologist loads the embryos into the
inner tube and then brings it into the theatre.
 The lights are dimmed and then the inner tube is
guided through the outer tube till the tip of the
catheter is 0.5 to 1cm from the fundus.
 Once the catheter is properly placed, the
embryologist then slowly injects the embryos
into the uterus.
 The catheter is then slowly withdrawn.
 The injected embryos will be seen on the
abdominal scan as a transfer bubble.
ZYGOTE INTRAFALLOPIAN
TRANSFER (ZIFT)
 ZIFT is an assisted reproductive procedure
similar to in vitro fertilization and embryo
transfer, the difference being that the fertilized
embryo is transferred into the fallopian tube
instead of the uterus.
 Because the fertilized egg is transferred
directly into the tubes, the procedure is also
referred to as tubal embryo transfer (TET).
 ZIFT AND GIFT
 This procedure can be more
successful than gamete intrafallopian
transfer (GIFT) because your physician has a
greater chance of ensuring that the egg is
fertilized.

 The main difference between ZIFT and GIFT is

that ZIFT transfers a fertilized egg directly into
the fallopian tubes while GIFT utilizes a
mixture of sperm and eggs.
HOW IS ZIFT PERFORMED
LAPARASCOPICALLY?

 ZIFT is an assisted reproductive procedure

that involves the following steps:

 During the ZIFT procedure, fertilized eggs are

transferred within 24 hours, versus 3-5 days as
used in a regular IVF cycle.
 LAPAROSCOPIC METHODS
 The fertilized eggs are then transferred
through a LAPAROSCOPIC procedure where
the right fallopian tube is picked up with a
grasping forceps and the embryo inserted into
the fimbrial end through a catheter.

 The final step is to watch for

early pregnancy symptoms. The fertility
specialist will probably use a blood test to
determine if pregnancy has occurred.
 LAPAROSCOPIC
Zygote intrafallopian transfer
KEY NOTE
 ZIFT is commonly chosen by couples who
have failed to conceive after at least one year
of trying and who have failed FIVE to SIX
cycles of ovarian stimulation with intrauterine
insemination (IUI).
With Nigeria current AFRH
president Dr Wada Ibrahim
With formal AFRH President
Dr. Faye Iketubosin
with international IVF
experts
Thanks for
listening!

54
For more information contact:

CHRISMAP GLOBAL HEALTHCARE

 Phone: 09059928066

 Email; [email protected]
References

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 Gardner DK, Schoolcraft WB, Wagley L, et al. Aprospective
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 World Health Organisation .WHO Laboratory manual for
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 Zayed F, Abu-Heija A. (1999). The managements of unexplained
infertility. Obstet Gynecol Surv .