CASE PRESENTATION

ON
INFERTILITY

SUBMITTED TO
SUBMITTED BY
MRS. MADHURI
L BHAVANI
MADAM
MSC(N) 1ST YAER
LECTURER
GCON SOMAJIGUDA
GCON SOMAJIGUDA
 STUDENT BIO DATA

NAME : L BHAVANI

COURSE : MSc NURSING

SUBJECT : OGB nursing

TOPIC : infertility

METHOD OF TEACHING : case presentation

GROUP : MSc (N) 1ST YEAR

PLACE : MSc (N) 1ST YEAR CLASS ROOM

DATE : 27 /07/2024

DURATION : 30 MINUTES

A.V. AID : black board, charts, ohp, projector, flash

SUBMITTED TO : MRS MADHURI MADAM,

LECTURER (OBG DPT),

GCON, SOMAJIGUDA
 OBJECTIVES

GENERAL OBJECTIVES:

By the end of the case presentation, I will be able to gain in depth knowledge regarding

infertility and its management.

SPECIFIC OBJECTIVES:

At the end of case presentation, I will be able to;

1. collect the identification data from a patient with infertility

2. develop skills in interacting with staff and clients in the ward

3. identify the incidence of infertility

4. determine the etiological and risk factors of infertility

5. explain the pathophysiology of infertility

6. identify the clinical manifestations of infertility

7. enumerate the diagnostic procedures in infertility

8. describe the medical management of a client with infertility

9. identify the various treatment modalities in infertility and side effects of

the drugs and nursing responsibilities

[Link] skills in providing comprehensive nursing care according to the

nursing process basing on the priority of client needs

[Link] skills in applying nursing theories while providing nursing care

[Link] health education to the client with infertility

INTRODUCTION

AND

DEFINITIONS
 INTRODUCTION

Reproduction (or making a baby) is a simple and natural experience for most
couples. However, it is for some couples it is very difficult to conceive. There
are many causes of infertility, including some that medical intervention can
treat. About 40% of the issues involved with infertility are due to the man,
another 40% due to the women, & 20%result from complications with both
partners.

Infertility refers to the inability to conceive after having regular unprotected sex.
It can also be referred to as the biological inability of an individual to contribute
to conception or to a female who cannot carry a pregnancy to full term.

Infertility is a significant social and medical problem affecting couples

worldwide.

Types of infertility include:

Primary infertility: You’ve never been pregnant and can’t conceive after one
year (or six months if you’re 35 or older) of regular, unprotected sexual
intercourse.

Secondary infertility: You can’t get pregnant again after having at least one
successful pregnancy.

Unexplained infertility: Fertility testing hasn’t found a reason that a person or

couple is unable to get pregnant.

Infertility is a complex disorder with significant medical, psychosocial, and

economic aspects. Both the prevalence of infertility and the number of patients
seeking treatment of this disorder are increasing. While great strides have been
achieved in infertility therapy, evidence-based studies have questioned the
validity of historically accepted tests for its diagnosis.
An overview of the infertility evaluation in females will be reviewed here.
Infertility related to recurrent pregnancy loss and male factors are discussed
separately. (See "Evaluation and management of couple with recurrent
pregnancy loss" and see "Evaluation of male infertility").

DEFINITION

1. Infertility is defined as a failure to conceive within one or more years of

regular unprotected coitus.
2. Primary infertility denotes those patients who have never conceived.
Secondary infertility indicates previous pregnancy but failure to conceive
subsequently.
3. Fecund ability is defined as the probability of achieving a pregnancy
within one menstrual cycle. In a healthy young couple, it is 20 percent.
Fecundity is the probability of achieving a live birth within a single cycle.

D.C. Dutta

INCIDENCE

Eighty percent of the couples achieve conception if they so desire, within one
year of having regular intercourse with adequate frequency (4-5 times a week).
Another 10 percent will achieve the objective by the end of second year. As
such, 10 percent remain infertile by the end of second year.
 ETIOLOGY
AND
RISK FACTORS
 RISK FACTORS AND ETIOLOGICAL FACTORS

ACCORDING TO BOOK ACCORSING TO

PATIENT
CAUSES OF FEMAE INFERTILITY  Family hereditary
factors, there is history
of infertility in the family
to the great grandparents
and sisters.
 Defective ovulation:
Endometriosis is the
main cause of infertility
Causes of female infertility:
in the patient.
A. Defective ovulation:
 Hypertension patient
 1. Endocrine disorders
has been diagnosed with
 2. Physical disorders
hypertension since 3
 3. Ovarian disorders
months, has the family
 4. Endometriosis
h/o hypertension from
B. Defective Transport: grandparents and parents.
 1. Ovum
 2. Scar tissue after abdominal surgery
 3. Sperm
 4. Cervix
C. Defective Implantation:
 1. Congenital anomaly and fibroids

CAUSES OF INFERTILITY
 Conception depends on the fertility potential of
both the male and female partner.
ACCORDING TO BOOK ACCORSING TO
PATIENT
Faults in the male: o In the male partner
o Defective spermatogenesis everything was fine
o Obstruction of the efferent duct system o The sperm count was
o Failure to deposit sperm high in the vagina normal
o Errors in the seminal fluid. o No other abnormalities

Congenital: Undescended testes: The hormone

secretion remains unaffected, but the spermatogenesis
is depressed. Vas deferens is absent (bilateral) in about
1-2 percent of infertile males.
Kartagener syndrome (autosomal disease) - there is
loss of ciliary function and sperm motility.
Hypospadias causes failure to deposit sperm high in
vagina.
Thermal Factor: The scrotal temperature is raised in
conditions such as varicocele. Varicocele probably
interferes with the cooling mechanism or increases
catecholamine concentration. However, no definite
association between varicoceles and infertility has been
established.
Infection:
(a) Mumps orchitis after puberty may permanently
damage spermatogenesis.
(b)The quality of the sperm is adversely affected by
chronic systemic illness like bronchiectasis.
Bacterial or viral infection of the seminal vesicle
or prostate depresses the sperm count.
(c) T. mycoplasma or Chlamydia trachomatis
infection is also implicated.

PATHOPHYSIOLOGY
OF
INFERTILITY
 PATHOPHYSIOLOGY
ACCORDING TO BOOK ACCORSING TO
PATIENT
ENDOMETRIOSIS is defined as endometrial tissue o Family hereditary
outside the uterine cavity. The diagnosis is based on the factors, there is history of
histological identification of endometrial glands and/or infertility in the family to
stroma outside the uterus. Endometriosis is most the great grandparents
commonly found in the pelvis but can spread and sisters. Delay in
throughout the entire abdomen and affects 10% to 15% diagnosis of the
of reproductive-age women. Of women with infertility condition
endometriosis, 40% to 50% will experience infertility. caused infertility in the
Endometriosis is categorized into four stages, according client. With the
to the American Society of Reproductive Medicine, anxiousness to conceive
with stage I being minimal and stage IV severe. couple went to hospital
Endometriosis is known to cause infertility, but the for cause of not getting
pathophysiology is thought to change according to the conceiving even after
stage. For stages I and II, infertility is believed to be sexual contact in a period
associated with inflammation with increased production after one year, with the
of prostaglandins and cytokines, macrophages, and investigations diagnosed
natural killer cells. The inflammation impairs ovarian as Defective ovulation:
and tubal function resulting in defective follicular Endometriosis is the
formation, fertilization, and implantation. Stages III and main cause of infertility
IV are associated with pelvic adhesions and/or masses in the patient. Delay in
that distort pelvic anatomy; this will inherently impair the treatment of the
tubal motility, oocyte release, and sperm motility. Also, condition due to poor
advanced endometriosis is hypothesized to impair financial status. The
folliculogenesis, which reduces the fertilization patient discontinued the
potential. course and that lead to
permanent infertility.
OBESITY PATHOPHYSIOLOGY IN INFERTILITY
 CLINICAL
MANIFESTATIONS
OF
INFERTILITY
 CLINICAL MANIFESTATIONS
ACCORDING TO BOOK ACCORSING TO
PATIENT
SYMPTOMS:
 The main symptom of infertility is not o Inability to conceive in
getting pregnant. There may be no other marriage life of 14
clear symptoms. years
 Some women with infertility may have o Presently patient
irregular menstrual periods or no periods. complaining of
 And some men may have some symptoms abnormal uterine
of hormonal problems, such as changes in bleeding since 4
hair growth or sexual function. months.
 Many couples eventually will conceive — o Headache
with or without treatment. o Hypertension
DIAGNOSIS
OF
INFERTILITY
 DIAGNOSIS AND TESTS
ACCORDING TO BOOK ACCORSING TO
PATIENT
DIAGNOSIS: 1. FBS-98MG/DL
 History collection 2. CBP-HB:8.4G/DL
 Physical examination 3. PLT-1.48 LAKHS

 Blood examination 4. CUE: ALB & SUG –

 Urine examination NIL

5. SODIUM: 139
SPECIFIC INVESTIGATIONS:
6. POTASSIUM: 4.26
Female infertility diagnosed
7. CHLORIDE: 103
Fertility for people with a uterus involves ovulating
8. CALCIUM: 6.3
healthy eggs. This means brain has to send hormonal
9. Thyroid profile: normal
signals to ovary to release an egg to travel from ovary,
[Link] analysis: normal
through fallopian tube and to uterine lining. Fertility
[Link] markers normal
testing involves detecting an issue with any of these
[Link]: A-VE
processes.
[Link] ABDOMEN:
These tests can also help diagnose or rule out
BULKY UTERUS
problems:
[Link]: endometriosis:
Pelvic exam: health provider will perform a pelvic
ET: 11mm
exam to check for structural problems or signs of
disease.
Blood test: A blood test can check hormone levels to
see if hormonal imbalance is a factor or if ovulating.
 TSH
 AMH
 LH
  PROLACTIN
 ESR
 FBS, PLBS
 VIRAL MARKERS
 CBP
 BGT
Transvaginal ultrasound: health provider inserts an
ultrasound wand into vagina to look for issues with
reproductive system.
Hysteroscopy: health provider inserts a thin, lighted
tube (hysteroscopy) into vagina to examine uterus.
Saline sonohysterogram (SIS): health provider fills
uterus with saline (sterilized salt water) and conducts a
transvaginal ultrasound.
Sono hysterosalpingogram (HSG): health provider
fills fallopian tubes with saline and air bubbles during
an SIS procedure to check for tubal blockages.
X-ray hysterosalpingogram (HSG): X-rays capture an
injectable dye as it travels through fallopian tubes. This
test looks for blockages.
Laparoscopy: health provider inserts a laparoscope
(thin tube with a camera) into a small abdominal
incision. It helps identify problems like endometriosis,
1. Semen analysis:
uterine fibroids and scar tissue.
normal
Male infertility diagnosed
2. All other parameters
Diagnosing infertility in people with a penis typically
are normal in male
involves making sure a person ejaculates healthy sperm.
partner.
Most fertility tests look for problems with sperm.
These tests can help diagnose or rule out problems:
Semen analysis: This test checks for low sperm count
and poor sperm mobility. Some people need a needle
biopsy to remove sperm from their testicles for testing.
Blood test: A blood test can check thyroid and other
hormone levels. Genetic blood tests look for
chromosomal abnormalities.
 TSH
 ESR
 FBS, PLBS
 VIRAL MARKERS
 CBP
 BGT
Scrotal ultrasound: An ultrasound of scrotum
identifies varicoceles or other testicular problems.
MANAGEMENT
OF
INFERTILITY
 MANAGEMENT AND TREATMENT
ACCORDING TO BOOK ACCORSING TO
PATIENT
Treatment for infertility depends mostly on the cause Tab: Amlokind/5mg/OD
and goals. Age, how long been trying to conceive and
Tab: BC/Ca+/VIT-C/OD
personal preferences are factors in deciding on a
treatment. Sometimes, one person needs treatment, but
Tab: Folic Acid/5mg/OD
other times, treatment involves both partners.
In most cases, people and couples with infertility have a Tab: Tranexa/500MG/BD
high chance of pregnancy. Things like medication,
Tab: Pan/40mg/OD
surgery or assisted reproductive technology (ART) can
help. Often, lifestyle changes or improving the
frequency and timing of intercourse can improve
chances of pregnancy. Treatment can also include a
combination of methods.
Infertility treatment for women
Treatments for infertility in women and people
assigned female at birth include:
Lifestyle modification: Gaining or losing weight,
stopping smoking or using drugs, and improving other
health conditions can improve chance of pregnancy.
Medications: Fertility drugs stimulate ovaries to
ovulate more eggs, which increases chance of getting
pregnant.
Surgery: Surgery can open blocked fallopian tubes and
remove polyps, fibroids or scar tissue.
Providers may make suggestions on how can improve
odds of conceiving.
These may include things like:
• Tracking ovulation through basal body
temperature, using a fertility tracking app and noting
the texture of cervical mucus.
• Using a home ovulation kit, a kit can purchase at
the drug store or online to help predict ovulation.
Infertility treatment for men
Treatments for infertility of penis or testes include:
Medications: Medications can raise testosterone or
other hormone levels. There are also drugs for erectile
dysfunction to help maintain an erection during sex.
Surgery: Some men need surgery to open blockages in
the tubes that carry sperm or to repair structural
problems. Varicocele surgery can make sperm healthier
and improve the odds of conception.
Some couples need more help conceiving using assisted
reproductive technology (ART). ART is any fertility
treatment that involves a healthcare provider handling
the sperm or egg.
To increase pregnancy odds, can take medications to
stimulate ovulation before trying one of these
options:
In vitro fertilization (IVF):
IVF involves retrieving eggs from ovary, then placing
them with sperm in a lab dish. The sperm fertilizes the
eggs. A provider transfers one to three of the fertilized
eggs (embryos) into uterus.
Intracytoplasmic sperm injection (ICSI):
This procedure may be performed during the IVF
process. An embryologist injects a single sperm directly
into each egg. Then, a provider transfers one to three of
the embryos into uterus.
Intrauterine insemination (IUI):
A healthcare provider uses a long, thin tube to place
sperm directly into uterus. IUI is sometimes called
artificial insemination.
Assisted hatching:
A process that involves opening the outer layer of an
embryo to make it easier for it to implant in uterine
lining.
Third-party ART:
Couples may use donor eggs, donor sperm or donor
embryos. Some couples need a gestational carrier or
surrogate.
Complications of infertility treatment include:
Higher chance of multiples (twins, triplets or more):
Producing multiple eggs and transferring more than one
embryo increases risk of becoming pregnant with more
than one fetus. Complications such as miscarriage,
premature birth, low birth weight, neonatal death, and
long-term health complications are more common in
people pregnant with multiple foetuses.
Ovarian hyper stimulation syndrome (OHSS):
A condition that causes painful and swollen ovaries as a
result of fertility medications. It can become serious
and require immediate medical attention.
Ectopic pregnancy:
IVF has an increased risk of ectopic pregnancy.
Failed cycles:
A failed cycle is when go through infertility treatment
and it doesn’t end in pregnancy. Infertility be cured, but
it depends on the cause. In 85% to 90% of cases,
lifestyle modification, medication, ART or surgery can
treat infertility and allow a person to conceive.
PREVENTION
• Eat a well-balanced diet and maintain a weight o Advised the patient to
that’s healthy. Eat a well-balanced diet
• Don’t smoke, misuse drugs or drink alcohol. and maintain a weight
• Get treated for STIs. that’s healthy
• Limit exposure to environmental toxins. o Educated about STIs.
• Stay physically active, but don’t overdo exercise.
• Don’t delay conception until an advanced age.
• Undergo fertility preservation procedures
(freezing eggs or sperm).
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION
[Link] Fluid and electrolyte Will be able to Assess the skin To identify the degree of Patient feeling
Syncope imbalance related to improve fluid and integrity fluid and electrolyte comfortable
[Link] delivery and electrolyte balance Assess fluid intake imbalance
Sunken eyes and dry preeclampsia as Check weight daily and out put To identify the fluid
skin evidenced by sunken Asses the amount ofbalance
eyes and dry skin bleeding and numberTo identify the amount of
of dipers chanced per
blood loss
day To maintain fluid. and
Encourage intake ofelectrolyte balance
more oral fluids at
frequent intervals
Educated about
importance of intake
fruits and fresh
vegetables
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION
[Link] Altered coping Will be able to coping
Encourage the mother
To know the psychological
Patient came out from
Anorexia mechanism related tomechanism depression
to ventilate her
status of the mother
Objective data health as evidenced by
Assess the level of
emotions
Depression. depression, anorexia coping mechanism
To overcome from the
greving and grieving Able to cope up the
stress
situation

To reduse depression

Provide psychological
Health education regarding
support to the mother
coping mechanisms
Provice divisional

therapy
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION
Subjective Acute pain, headacheNormalise Maintain bed rest Patient comfortable on Patient comfortable
data related to increased Vascular pressure quiet neighbourhoodbed.
Headache, Vascular pressure and make patient limited activity Calms quiet Environment
SOB, Fatigue comfotable Maintain provided.
Confusion, and environmental Bp-130/90
pain stimuli -P/R-60lmt
Objective data Vital monitoring. Relaxation with music
Patient has increased provider ice packs, Tab: pcm 5000g bd
B.p and Relaxation Health education on diet in
technique HPD.
Counselling the \ - Counselled The patient
client
Medical
Collaboration
providing analgesics
and Sedative drugs.
Health Education
BIBLIOGRAPHY

 D.C Dutta's, "Textbook of Obstetrics", 7 ed. 2013, New Central

Book Agency (P) Ltd. London, page no:- 260-268

 Annamma Jacob, A Comprehensive textbook of midwifery &

gynaecological nursing", 3" ed. 2012, Jaypee Brothers Medical

Publishers (P) Ltd., page no:323-330

 Myles, "textbook of midwives", 6" ed. 2014, Elvester (Ltd), page

no: 273-275

 [Link]