Presented by:

Miss.N.Vineetha,
MSc (N)- I st Year,
SPGCON,
Tirupati.
C Contents of Presentation:

Introduction about Infertility

Causes of male and female

infertility

Management of Infertility in
both Women and Men
INFERTILITY:

 Infertility is “a disease of the reproductive system

defined by the failure to achieve a clinical pregnancy
after 12 months or more of regular unprotected sexual
intercourse.
 An estimated 34 million women, predominantly from
developing countries, have infertility which resulted
from maternal sepsis and unsafe abortion. Infertility in
women was ranked the 5th highest serious global
disability.
 Types of Infertility:

There are 2 types of infertility

1) Primary Infertility
2) Secondary Infertility
 Primary Infertility:
Primary infertility is when a couple has not conceived
after trying for at least 12 months without using birth
control
 Secondary Infertility:
Secondary infertility is when they have previously
conceived but are no longer able to.
Causes for male infertility:
4. Retrograde ejaculation:
Sperm can be taken directly from the bladder and injected
in to an egg.

5. Surgery for epididymal blockage:

A bypass of the blockage can be performed known as Vaso
epididymostomy (Vas defences is reconnected to
epididymis).

6. Orchidopency in un dressed testes should be done between

2-3 years of age to have adequate spermatogenesis in late
life.
1). Ovulation Disorders:
Fertility drugs were prescribed
a) Clomiphene citrate:
 To encourage ovulation ( in case of PCODS),
 Initial Dose 50 mg daily, dose increased in 50 mg steps to
maximum 250 mg daily.
MOA:
 It is an anti- oestrogenic as well as weakly oestrogenic.
 It blocks the oestrogen receptors in the hypothalamus.
 Anti- oestrogenic effects are seen on the endometrium and
on the cervical mucus.
Side effects:
Nausea, Vomiting, Headache, Visual Symptoms, Incidence
of abortion, Hot flushes.
b) Metformin:
 Client who do not respond to Clomiphene citrate
 Especially when client with PCOS inked to insulin
resistance.
c) FSH:
 A Hormone produced by Pituitary gland
 Control oestrogen production by ovaries
 It stimulates ovaries to mature egg follicles e.g. Gonad-F,
Repronex, Follistin ( given S/C).
d) Human Menopausal Gonadotrophin:
 In case of absent ovulation due to pituitary dysfunction
 Contains both FSH and LH
E.g. Bravelle, Responex, Menopus given ( IM or SC)
e) Human chorionic Gonadotrophin:
 Given in combination Comiphene+HMG+ FSH
 It stimulates follicles to ovute
 Given in IM or SC
f) Gn-RH:
 Delivers constant supply of Gn-RH to pituitary gland,
which alters the production of hormone, that allows induces
to follicle growth with FSH.
 Given by intra nasal, S.C injection
g) Bromocriptine:

 Stimulates ovulation by inhibiting production of prolactin

 Prolactin stimulates milk production in lactating mothers
 e.g. Parlodel, Cycloset-oral or IV.
2) Surgery:
a) Laparoscopic ovarian drilling (LOD) OR Laser vaporization for
polycystic ovarian syndrome (PCODS)
b) Surgical removal of virilizing or Functioning ovarian or adrenal
tumor.
c) Tubar anastomosts for adhesion in tube
d) Camulation and balloon tuboplsty for block in tube
e) Fimbrioplasty for fimbrial adhesion
f) Adhesiolysis for separation or division of adhesion
g) Sapingostomy to create an opening in tube in a completely
occluded tubes.
Drugs under investigation for the treatment of Infertility:

 Follitropin delta
 FE 999049
 Rekovelle
 Recombinant FSH
REFERENCES:

1. WHO-ICMART glossary,
2. Balen, Adam H, and Anthony J Rutherford.
“Management of infertility.” BMJ (Clinical research ed.)
vol.335,7620 (2017): P.g no:608-11.
3. https://clinicaltrials.gov/ct2/home.
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