SEMINAR ON
INFERTILITY
submitted to,
Leena abraham
Prof.&HOD of OBG Dept.
Prepared By
Delphy varghese
1st year msc nursing
INFERTILITY
DEFINITION
Infertility is defined as a failure to
conceive within one or more years
of regular unprotected coitus.
TYPES OF INFERTILITY
Primary infertility
Secondary infertility
Primary infertility:
Primary infertility is a term used to describe a
couple that has never been able to conceive a
pregnancy after a minimum of 1 year of
attempting to do so through unprotected
intercourse.
Secondary infertility:
Secondary infertility is the inability to
become pregnant or to carry a baby to
term after previously giving birth to a
baby.
CAUSES OF INFERTILITY
MALE INFERTILITY FACTORS
Defective spermatogenesis
Obstruction of the efferent duct system
Failure to deposit sperm high in vagina
Errors in seminal fluids.
FEMALE INFERTILITY FACTORS
Ovarian factors
Tubal factors
Uterine factors
Cervical factors
Vaginal factors
OTHER FACTORS
General factors : age
Lack of knowledge of coital technique
Immunological factors Congenital
Thermal factor
Infection
General factors
Endocrine
Genetic
Latrogenic
Immunological factors
DIAGNOSTIC PROCEDURE
PROCEDURES FOR MALE
General physical examination and medical history
Semen analysis
Scrotal ultrasound
Hormone testing
Post-ejaculation urinalysis
Genetic tests
Testicular biopsy
Specialized sperm function tests
Transrectal ultrasound
DIAGNOSTIC PROCEDURE FOR FEMALES
ENDOCRINE SYSTEM TESTS
TESTS FOR PELVIC DISORDERS
TESTS RELATED TO THE CERVIX
ENDOCRINE SYSTEM TESTS
1) Basal Body Temperature Charting (BBT)
2) Endometrial Biopsy
3) Testing for Luteinizing Hormone
4) Ultrasonography
5) Testing the Health of the Ovaries
6) Laparoscopy
7) Other Female Endocrinology Tests
TESTS FOR PELVIC DISORDERS
Ultrasonography and sonohysterography
Hysterosalphingogram
Hysteroscopy
Magnetic resonance imaging (MRI)
laproscopy
TESTS RELATED TO THE CERVIX
1) History of Sexual Intercourse
2) Tests for Sexually Transmitted Disease
3) Post-Coital Test
4) Antisperm Antibody Tests
TREATMENT
RESTORE FERTILITY THROUGH
Medication
Surgery
Medication
Clomiphene citrate
Gonadotropins
Metformin. Metformin
Letrozole. Letrozole
Bromocriptine. Bromocriptine
Fertility restoration: Surgery
Laparoscopic or hysteroscopic surgery
Tubal surgeries
RECENT ADVANCEMENT IN
INFERTILTY MANAGEMENT
Types Of ART Procedure In
Practice:
IUI : Intra uterine insemination
GIFT
IVF – ET : In vitro fertilization & embryo transfer
: Gamete intra – fallopian transfer
ZIFT : Zygote intra – fallopian transfer
POST : Peritoneal oocyte & sperm transfer
SUZI : Sub zonal insemination Micro Assisted Fertilization (MAF)
ICSI : Intra – cytoplasmic sperm injection/insemination
Methods of sperm recovery :
TESE : Testicular sperm extraction
MESA : Micro surgical epididymal sperm aspiration
PESA : Percutaneous epididymal sperm aspiration
Intrauterine Insemination (IUI) :
is a fertility treatment that involves placing
sperm inside a woman’s uterus to facilitate
fertilization. The goal of IUI is to increase the number
of sperm that reach the fallopian tubes and
subsequently increase the chance of fertilization. IUI
provides the sperm an advantage by giving it a head
start but still requires a sperm to reach and fertilize the
egg on its own
In Vitro Fertilization and Embryo
Transfer (IVF-ET)
GIFT (Gamete Intra – Fallopian Transfer)
ZIFT ( Zygote intra – fallopian transfer)
POST : Peritoneal oocyte &
sperm transfer
In this method, sperm and eggs are directly
placed into the peritoneal cavity near the
fallopian tubes, under ultrasound guidance,
immediately after transvaginal ultrasound
guided egg collection has been performed.
ICSI : Intra – cytoplasmic sperm
injection/insemination
Methods of sperm recovery :
Testicular Sperm Extraction (TESE)
TESE is often used to diagnose the cause of azoospermia.
It can also get enough tissue for sperm extraction. The
sperm can be used fresh or frozen (“cryopreserved”).
TESE is often done in the urologist's office with a nerve
block. A nerve block is an anesthetic injected into
nerves to treat pain. The nerve block will "turn off" a
pain signal from a specific location; in this case, from
the testis. Or, TESE can be done under anesthesia in a
surgical center. It involves one or several small cuts in
the testes.
Testicular Sperm Aspiration (TESA)
TESA is also sometimes called Testicular Fine
Needle Aspiration (TFNA). TESA can be used
to diagnose or treat azoospermia. It can also
be used to collect sperm from the testicles.
It's often done with a nerve block. A thin
needle punctures the skin and testis to
gently pull out sperm. No other cuts are
needed.
Microsurgical Epididymal Sperm
Aspiration (MESA)
MESA uses a surgical microscope to
help retrieve sperm from the
epididymis tubes. MESA can retrieve
lots of healthy sperm that can be
saved and frozen for later.
Percutaneous Epididymal Sperm Aspiration
(PESA)
PESA, like TESA, can be done many times at low
cost and without a surgical cut and is especially
suited for obstructive azoospermia. a needle
attached to a syringe into the epididymis to
gently remove fluid. Sperm may not always come
out this way. Sometimes a surgical process is
needed
ETHICAL AND LEGAL ASPECTS
OF ASSISTED REPRODUCTIVE
TECHNOLOGY
Artificial Insemination
surrogate Motherhood
In-vitro Fertilization
Artificial Insemination
accept the impregnation of one's wife by the
sperm of a third person as it doesn't make the
child one's own and is looked down upon as
illegitimate even in man made laws. The donation
is, however, always made anonymously so that
the father could not be traced by the child, nor
can the father elect to make contact with the
child, potentially disrupting a harmonious family.
surrogate Motherhood
Surrogacy throws up another problem of post
partum blues if the mother and the baby bonds.
Ethically also subrogation raises many issues like
tempering with the normal process of
procreation, undermining the institution of
marriage and family life, treating children as
objects of sale etc.
In-vitro Fertilization
Donation of sperms and ova, and the use of
surrogate motherhood to bear the child are both
contrary to the unity of marriage and the dignity
of procreation of human being. Furthermore
these procedures lend themselves to
commercialization and exploitation when people
are being paid for sperm, ova and for surrogate
motherhood The in-vitro fertilization is acceptable
within limits.
ADOPTION PROCEDURE
Adoption is the infertile couples consider
one of the alternative methods for resolving
their infertility
METHODS OF ADOPTION
1)Agency adoption
2) International adoption
3) Private adoption
Adoption Procedure
Child welfare agency
Registration
Documents
Home visits by social worker
Patience waiting
Meeting the child
Medical checkup
Formalities in the court
Court decree
Follow-up visits
CRITERIA FOR PROSPECTIVE ADOPTIVE PARENTS
Marital status, age, financial status and clear police record should be evident
in the home study report by the social worker.
Couples having composite age of 90 years and less and where neither parent
has crossed 45 years.
the age limit of adoptive parents may be relaxed by the central government
for special cases
Single persons who have not crossed the age of 45 years
regular source of income of Rs 3000/month
All the criteria mentioned above will also apply to single parents
The age difference between the adoptive single parent and child should be 21
years.
The single parent should have additional family support system.
CRITERIA FOR ELIGIBLE CHILDREN
The child should be legally free for adoption.
Siblings/ twins/ triplets etc. should not be separated.
The consent of children above 6 years should be taken
for the adoption.
Adoption laws in India
The Hindu Adoption and Maintenance Act, 1956
(HAMA
The Guardians and Wards Act, 1890 (GWA)
The Juvenile Justice (Care and Protection) Act of
2000, amended in 2006 (JJ Act)
Reliable Indian adoption agencies
SOS Children’s Villages in India
Holy Cross Social Service Center
Missionaries of Charity
Church Of North India
Welfare Homes for Children
Delhi Council for Child Welfare
Matri Chhaya
Children of the World
Right to Life Society
Asharan Orphanage
Conclusion
Although infertility in common in
both male and female, the latest
treatment methods and techniques
have proven to be effective
treatment method
ROLE OF NURSE IN INFERTILITY
Receiving the patient and family, and make them
accessible and comfortable for counseling
Fertility nurse specialist provide care for the
individuals and couples before, during, and after
fertility treatment
Nurses need to obtain history as a prenatal,and other
relevant information regarding patients of reports
Give physiological support throughout the counseling.
Collect other information about tests reports and
documents.
Conti..
Establish plan of care with family and coordinate care
with other health care professionals.
Maintain privacy and confidentiality of all cases.
Performing inseminations
Ensure follw-up at supportive services to individual
and family during counseling
THANK YOU
