SEMINAR ON

INFERTILITY (ADOPTION PROCEDURES, ROLE

OF NURSE IN INFERTILITY MANAGEMENT)

SUBMITTED TO SUBMITTED BY

Mrs.Ritanjali Sahoo Mrs.Suchismita Sahu

HOD OBG Department 1st year Msc Nursing

College Of Nursing,Cuttack College Of Nursing,Cuttack

DATE:-

PLACE:-

INDEX
SI CONTENT PAGE NO
1
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1 INTRODUCTION 3

2 INFERTILITY
Definition 3
Incident 3
Factor affecting fertility 3-4
Couses 4-5
Investigation 5-6
Diagnosis 6
Treatment 6-8
Prognosis 9

3 ADOPTION PROCEDURE
Definition 10
Requirement 10-11
Law governing adoption 11-15

4 ROLE OF NURSE 15-16

5 CONCLUSION 17

6 BIBLIOGRAP 18
INFERTILITY
INTRODUCTION:-
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  Infertility is the inability to achieve and sustain a pregnancy to
delivery after at least 1 year of regular unprotected ejaculatory
vaginal sexual intercourse with an adult of the opposite sex.
 Subfertility – a special cases of infertility when there are deliveries
but not having any or desired number of children alive.
 Infertility is worldwide problem affecting 5-20% of couple.

DEFINITION:-
According to WHO “Infertility is a disease of the reproductive system
defined by the failure to achieve a clinical pregnancy after 12 month or
more of regular unprotected sexual intercourse. Primary infertility is
infertility in a couple who have never had a child. Secondary infertility is
infertility is failure to conceive following a previous pregnancy.”

INCIDENT:-
 80% of couple achieve conception if they so desire, within one
year of having regular intercourse with adequate frequency.
 Another 10% will achieve the objective by the end of second year.
 As such, 10% remain infertile by the end of second year.

FACTORS AFFECTING FERTILITY:-

 AGE:- 9-16 years irregularity of menstrual cycle. Age >35 years
reduction in ovulation potential.
 Social / Nutritional status/ Income.
 Education :- educated women tend to delay conception.
 Marital status.
 Occupation
 Exposure to environmental toxicant.
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  Uncertain factor.

CAUSES:-
MALE INFERTILITY:-
Men are responsible for 33.3% of infertility cases.

Male factors are as follow:-

 Testicular varicose
 Genital infection
 Mumps orchitis
 Scrotal surgery
 Smoking/ Alcohol intake
 Chronic or serious systemic illness

FEMALE INFERTILITY:-
Females are responsible for 25% of infertility cases.

Female factors are as follow:-

 Tuber disease like blockage or adhesion

 Anovulation – Regular
- Oligo-ammenorrhae
- High prolactine level

 Uterine facors – fibroids at the corpus or cervix

- Endometriosis
- Uterine synaechae
- Cervical incompetence
- Aplasia / Dysplasia
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  Vaginal factor- gynaetresia

COMBINED FACTOR:-
 Advance age of wife beyond 35.
 Over weight.
 Infrequent intercourse.
 Anxiety.
 Use of lubricant during intercourse.
 Immunological factors.

INVESTIGATION:-
MALE:-
 History collection
 Examination
 Routine investigation
 Seminal fluid analysis
 Sperm function test
 Testicular biopsy
 Transrectal ultrasound
 Vasogram

FEMALE:-
▪HISTORY:
 A general medical history
 The surgical history

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  Menstrual history
 Previous obstetrics history
 Contraceptive practice
 Sexual problem

▪EXAMINATION:

 General examination
 Systemic examination
 Gynecological examination
 Speculum examination

▪DIGNOSIS:

1. INDIRECT:
 Menstrual history
 Sonography
 Cervical mucus study
 Vaginal cytology
 Endometrial biopsy
 Hormone estimation
2. DIRECT:
 Laparoscopy

TREATMENT:-
 Couple instruction:
o Assurance
o Body weight
o Smoking and alcohol
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 o Coital problem

TREATMENT FOR MALE INFERTILITY:-

To improve spermatogenesis the following measures should be useful.

GENERAL CARE:-

 Improvement of general health, reduction of weight in

obese, avoidance of alcohol and heavy smoking.
 Avoidance of tight and warm undergarment or
occupation that may elevate testicular temperature.
 Use of vitamins E, C, D, B12 and antioxidant to improve
spermatogenesis.
 Medication that interfere spermatogenesis should be
avoided.
 In hypogonadotrophic hypogonadism, the disorder of
spermatogenesis can be treated with hcg 500 IU
intramuscularly once a week or Dopamine agonist.
 Clomiphene citrate 25-50 mg orally daily for25 days with
rest for 5 days for 3 cycles. It increases serum level of
FSH, LH AND Testosterone.
 Genital tract infection need antibiotic like doxycycline or
erythromycin for 4-6 weeks depending on response.
 In retrograde ejaculation-phenylephrine is used to
improve the tone of internal urethral spincter.
 In teratospermia, asthenospermia no treatment is
available. Donor insemination is the option.
 In genetic abnormalities, artificial insemination with
donor sperm is the option.

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SURGICAL:

 Vasoepididymostomy or vasovasostomy
 Hydrocele is corrected by surgery
 Orchidopexy in undecended testes should be done
between 2-3 years of age.

IMPOTENCY:

 Psychosexual treatment
 For erectile dysfunction, sildenafil 25-100 mg or
tadalafil 10-20 mg is currently activities should be
given.

TREATMENT FOR FEMALE INFERTILITY:-

1. Ovulatory
2. Tubal
3. Associate disorder like endometriosis, infection
4. Cervical
5. Immunological
6. Unexplained infertility
7. Uterovaginal canal
8. ART

PROGNOSIS:-
 The pregnancy rate within 2 years after the start of investigation,
range between 30-40%.
 The rate will increase up to 50-60% if AID cases are included.
 Adoption is the alternative for many couple.

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 ADOPTION PROCEDURE
DEFINITION:-
Adoption is a legal process by which a child is placed with a married
couple or a single female who agree to raise his /her as their own child
and assume all responsibility of the child.

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REQUIREMENTS FOR A VALID ADOPTION:-
No adoption is valid unless:-

 The person adopting is lawfully capable of taking in adoption.

 The person giving in adoption is lawfully capable of giving in
adoption.
 The person adopted is lawfully capable of being taken in adoption.
 The adoption is completed by an actual giving and taking and after
the ceremony called Datta Homan has been performed. However
this may not be essential in all cases as to the validity of adoption.

WHO MAY ADOPT A CHILD:-

 An Indian
 Nonresident Indian
 A foreign citizen
 A single female(unmarried, widow or divorced)
 A married couple

WHO CAN GIVE CHILD IN ADOPTION:-

Parent / guardian or child

 Both parents are together.

 One of them if the other has renounced world.
 If both parents are dead or not competent in law or child’s
parentage unknown then guardian can give child in adoption with
permission of court.

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ELIGIBILITY OF THE ADOPTIVE PARENTS:-
 Must be over 21 years.
 Financial ability to raise the child.
 Adopted child not be as same as adoptive parent’s living child.
 Cannot adopt more than one child of same sex.

LAWS GOVERNING ADOPTION:-

HINDU ADOPTION AND MAINTENANCE ACT:-
 An adoptive parent is allowed to ask for a child , as per her
preferences(age, gender, skin, color, religion, specific features
and health condition).
 A single parent or married couple are not permitted to adopt
more than one child of the same sex.

PROCEDURE OF ADOPTION:-
STEP 1: REGISTRATION

 Register in a genuine adoption coordinating agency.

 Never register with multiple agency.
 Prepare the documentation, submit the same to the agency and
get registered.

STEP 2: HOME STUDY AND COUNSELLING

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  Home study at the couple’s residence.
 Assess the couple’s parenting abilities – applicant’s motivation,
preparations, strengths and weakness on the issue of adoption.
 This step is formulated into a report and is submitted to the
honorable.

STEP 3: REFERRAL OF THE CHILD

 The agency will show medical file, physical examination report

and other relevant information of the child.
 Once the couple is comfortable about the details given about the
child, the agency will show the child physically.
 The couple can spend time with the child.
 Once comfortable – future formalities.

STEP 4: ACCEPTANCE OF CHILD

 Once the couple identifies the child, they can sign the documents
pertaining to the acceptance of the child.

STEP 5: FILING OF PETITION

 Documentations made by the couple to the agency and the child’s

documents are sent to the lawyer for preparation of the petition.
 Once the petition is ready the couple will be called at the court
and sign the same in presence of the court officer.

STEP 6: COURT HEARING

 The couple should attend the court hearing along with the child
(not an open court).

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  The judge may ask simple questions. If satisfied will pass the order
and will also mention the amount to be invested in the child’s
name.

STEP 7: COURT ORDER

 Once the amount is invested and the receipt is shown to the judge
the order will be issued.
 If the adoption is under HINDU ADOPTION AND MAINTENANCE
ACT 1956, then a deed of adoption is prepared and the same
needs to be registered with the local register’s office.
 There is no such requirement in adoptions done under GOURDIAN
AND WARDS ACT 1890 & JUVENILE JUSTICE ACT 2000 acts.

STEP 8: FOLLOW UP

 After the final adoption the agency needs to submit follow up

reports to the court about the child’s well being.

GUARDIAN AND WARDS ACT OF 1980:-

 A foreign national adopts an Indian child under the provisions of
the Guardian And Wards Act, 1980.
 The adoptive parent is only the guardian of the child until she
reaches 18years of age.
 An adoptive parent is allowed to ask for a child as per the
preference.
 Foreign citizens and NRI’s supposed to adopt according to the
adoption laws and procedures in the country of their residency.

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PROCEDURE OF ADOPTION:-
 Register in a social or child welfare agency licensed or recognized
by the government of the country in which the foreigner resides.
 Agency will appoint a professional social worker to prepare a
home study report.
 Foreign national is required to submit supporting documents
along with his application and declaration of willingness.
 The application will be filed by Indian welfare agency or a person
duly authorized by them.
 The application will be filed by the Indian welfare agency or a
person duly authorized by them.
 The application for guardianship must be made before the court
of the district judge within whose jurisdiction the social and
welfare child agency in India that is processing the application of
the foreigner is located.
 The court will first hear all the concerned parties and examine all
the documents.
 The court must be satisfied that the foreigner will be a suitable
adoptive parent for the child and will provide the child a secure
and loving home.
 If the court is satisfied on all these counts, it will pass an order.

L.K pandey vs. union of India – The supreme court of India has laid
down certain guidelines for foreign adoption in an attempt to safeguard
the interests of the children.

 Application made under the guardians and wards act, 1890 has to
be disposed of within 2 month.
 Requirement for personal presence of the foreign national.
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JUVENILE JUSTICE ACT OF 2000:-
Children who have been abandoned or abused and not those children
who have been voluntary put up for adoption.

ROLE OF NURSE IN INFERTILITY MANAGEMENT:-

 Receiving the patient and family and make them accessible and
comfortable for counselling.
 Fertility nurse specialists provide care for the individuals and
couples before, during, and after fertility treatment.
 Nurse need to obtain history as prenatal, family and other
relevant history.
 Nurse has to perform primary physical examination and collect
other relevant information regarding patient of reports.
 Give physiological support throughout the counseling.
 Collect other information about tests, reports and documents.
 Establish plan of care with family and coordinate care with other
health care professional.
 Maintain privacy and confidentiality of all cases.
 Performing insemination.
 Performing embryo transfers.
 Ensure follow up and supportive services to individual and family
during counseling.

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CONCLUSION:-
Infertility is the inability to achieve and sustain a pregnancy to delivery
after at least 1 year of regular unprotected ejaculatory vaginal sexual
intercourse with an adult of the opposite sex.

 Subfertility – a special cases of infertility when there are deliveries

but not having any or desired number of children alive.
 Infertility is worldwide problem affecting 5-20% of couple.

Adoption is the creation of a new, permanent relationship between an

adoptive parent and child. Once this happens, there is no legal
difference between a child who is adopted and a child who is born into
a family.

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BIBLIOGRAPHY:-
▪ Margarets A. Cooper “MYLES TEXT BOOK FOR OBSTETRICS” 15TH
Editions, Chapter-3, PREPARATION FOR PREGNANCY, Elsevier
publisher , UK 2008, PAGE NO-180-188.

▪D.C Dutta “ TEXT BOOK OF OBSTETRICS” 7TH Edition, Chapter-

2,Fundamental of reproduction, New central book agency(P) Ltd,
Kolkata,2013, page no-21-27.

▪WWW.WIKIPEDIA.IN

▪WWW.LINK IN.COM

▪WWW.SCRIBE.IN

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