INDORE

2023-2024
OBSTETRIC & GYNAECOLOGICAL NURSING
PRACTICE TEACHING
on
INFERTILITY

SUBMITTED TO: SUBMITTED BY:

Dr. MANSI CHOUDHARY MS. MADHU BALA
ASSOCIATE PROFESSOR M.Sc. NURSING PREVIOUS YEAR
SAIMS COLLEGE OF NURSING INDORE SAIMS COLLEGE OF NURSING INDORE
 LESSON PLAN ON INFERTILITY
Guided by: Dr. Mansi Choudhary
Subject: Obstetric & Gynecological Nursing
Topic: Infertility
Group: MSc. Nursing 1st year
Place: SAIMS College of nursing Indore.
Date & time: ………. &………….
Method of teaching: Lecture cum discussion
A.V Aids: Black board, ppt slides, pamphlets, chart,

General objectives: At the end of class, student will be able to understand the topic and improve the knowledge regarding infertility.
Specific objective: -
 Define infertility.
 Enlist type of infertility.
 Explain causes of infertility in male & female factor.
 Elaborate investigation of male & female infertility.
 Describe management of infertility in male & female.
 Enumerate role of nurse in infertility management.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
1. 2 min. Introduce INTRODUCTION Lecture cum
topic.  Infertility is a significant social and discussion
medical problem affecting couples
worldwide. Infertility refers to an inability
to conceive after having regular
unprotected sex. Average incidence of
infertility is about 15% globally. (Varies in
different populations).
Some causes can be detected and
treated, whereas others can't : Unexplained
infertility constitutes about
10 % of all cases.

DEFINITION:
2. 3 min. Define Infertility is?
 Infertility is defined as a failure to conceive Lecture cum
infertility. within one or more years of Regular discussion.
unprotected intercourse.
OR
 “Infertility refers to inability to achieve
pregnancy after 12 months of having
unprotected sexual intercourse with
average frequency of 3 to 4 times per week
without use any birth control measures”.

3. 10 min. TYPES OF INFERTILITY.

Enlist the type  Primary infertility. Lecture cum How many types
of infertility.  Secondary infertility. discussion. of infertility?
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
1. Primary infertility: -
 Infertility without previous pregnancy.
 Primary infertility denotes couple who
have never been able to conceive.
2. Secondary infertility:
 Secondary infertility indicates difficulty
conceiving after already having conceived
and (either carried the pregnancy to term
or had a miscarriage.
4. 15 min Explain cause
CAUSE OF INFERTILITY.
of infertility Lecture cum How many
 Conception depends on fertility potential
in male & discussion. factors that
of both male and female partner.
female. affect the
Male factors:
fertility in male
o Defective spermatogenesis.
and female?
o Obstruction of efferent duct.
o Failure to deposit sperm high in vagina.
o Error in the seminal fluid.

o Defective spermatogenesis:
Congenital: due to undescended testes
spermatogenesis is depressed.
Hypospadias.
Thermal factors: Sperm cells tend to die
when exposed to too much
heat. Continuous exposure to higher
temperatures can cause sperm production
to be lower, or cause the production of
abnormal shape sperm cell resulting for
infertility.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
Infection / Inflammation or Trauma
Gonadotropin suppression.
Endocrine factors
Loss of sperm mortality.
Iatrogenic: cytotoxic drug, radiation
therapy, anti-depressant are likely to
obstruct spermatogenesis.
o Obstruction of efferent duct.
Gonococcal or tubular infection.
 The efferent ducts may be obstructed by
Gonococcal or tubercular Infections.
 Surgical trauma during vasectomy.
Surgical trauma during vasectomy or
hernioplasty may lead to obstruction
o Failure to deposit sperm high in vagina.
 Erectile dysfunction.
 Ejaculatory dysfunction such as
retrograde ejaculation.
 Hypospadias.
 Epispadias.
o Error in the seminal fluid.
 Low fructose content.
 High prostaglandin content.
 Hypospermia / low volume of ejaculation.
Female factor.
o Ovulatory dysfunction.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
o Tubal factor.
o Uterine factor.
o Cervical factor.
o Vaginal factor.

o Ovulatory dysfunction.
 Anovulation or oligo-ovulation.
 Decrease ovarian reserve.
 PCOS.
 Pre-mature ovarian failure.
o Tubal factor.
 Obstruction of fallopian tube.
 Peritubal obstruction.
 Endo-salpingeal damage.
 Salpingitis.
 Tubal spasm.
o Uterine factor.
 Uterine hypoplasia.
 Uterine fibroids.
 Endometritis.
 Endometriosis.
 Congenital malformation of uterus.
 Uterine synechiae.
o Cervical factor.
 Anatomic: congenital elongation of
cervix & second degree uterine prolapse.
 Physiologic:
The cervical mucus may be scanty
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
Following amputation, conisation, Cauteriza-
tion of the cervix.
Presence of anti-sperm & sperm immobilizing
antibody may be implicated as immunological
factors of infertility.
o Vaginal factor.
 Vaginal atresia. (Partial or complete).
 Transverse vaginal septum.
 Separate vagina.
 Narrow introitus causing dyspareunia are
included in the congenital group.
Combined factor
Age: fertility decrease with age, particularly
after the age of 35 because both the number
and quality of egg gets lower.
.
Smoking & Alcohol: smoking and alcohol
can damage the DNA in sperm and negatively
affect hormone production of both male and
female leading to cause fertility.
Diet: One study showed that many women
fail to meet nutrient needs—particularly in
terms of folic acid, calcium, iodine, iron,
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
selenium, vitamin D, and vitamin B-12—and
thus have lower blood concentrations (116).
Calcium, iron, zinc, magnesium, iodine, and
selenium are especially essential with
regard to fertility.
Stress: (in male) Stress may negatively
impact on fertility, by increasing adrenergic
activation, leading to more vasoconstriction in
the testes. This vasoconstriction results in a
lower testosterone level and decreased
spermatogenesis.
(in female) stress hormones such as cortisol
disrupt signaling between the brain and the
ovaries, which can trip up ovulation,”

Obesity: (in female) Overweight women

have a higher incidence of menstrual
. . dysfunction and anovulation. Overweight and .
obese women are at a high risk for
reproductive health.
(in male) Increased weight in men has been
associated with a lower testosterone level,
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
Poorer sperm quality, and reduced fertility as
compared to men of normal weight. The odds
of infertility increase by 10% for every 9 kg
(20 pounds) a man is over weight.
Caffeine: Excessive Caffeine may potentially
impact your ability to become pregnant.
Drug: For both men and women, taking
cocaine, heroin, ecstasy, cannabis and other
recreational drugs can reduce the chance of
having a baby. Taken over a long period of
time, recreational drugs can cause permanent
problems with the reproductive system
and infertility.

INVESTIGATION OF INFERTILITY
In male How many type
5. 7 min. Identifying i. General physical examination and . of investigation
investigation medical history. that are
of male & performed at the
female ii. Blood examination including sugar. time of infertility?
infertility.
iii. Semen analysis.
iv. Hormone testing.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
v. Scrotal ultrasound.
vi. Post-ejaculation urinalysis.
vii. Genetic test.
viii. Testicular biopsy.
In female
History
i. Age.
ii. Duration of marriage,
iii. Medical history,
iv. Menstrual history,
v. Previous obstetric history,
vi. Surgical history,
vii. Sexual problems.
Examinations
i. General examination
ii. Systemic examination
iii. Gynecology examinations
iv. Speculum examinations

Diagnostic evaluation
Similarly major defect in female
such as:
i. Menstrual history
ii. Cervical mucus study
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
iii. Hormone estimation
iv. Ultra Sonography
v. Endometrium biopsy
vi. Hysterosalpingography (reveal any
abnormality in Uterus )
MANAGEMENT OF INFERTILITY. Lecture cum How will you
6. 18 min Describe  Management of infertility or sub fertility discussion. manage
management would depend upon the cause infertility?
of infertility in Identified, duration & age of the couple,
male & especially the female.
female. General instructions :- when minor defects
are detected in both the husband and wife .
 Body weight
 Smoking & alcohol
 Psychological support should offered as
the couple may face significant stress &
sadness as the investigation consultation
progress.
Management of male infertility.
 The treatment of male partner is
indicated in:
 An extreme Oligospermia (low sperm
count).
 Azoospermia (absence of sperm).
 Low volume ejaculation.
1. Impotency (the condition or quality of
being impotent; weakness. Chronic inability
to attain or sustain an erection for the
performance of a sexual act.)
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
General care: improvement of general
health support.
Medications that interfere
spermatogenesis should be avoided.
Reduction of weight in obese.
Avoid alcohol or heavy smoking.
Avoidance of occupation that may
elevate testicular temperature.
In hypo gonadotropic HCG 5000 IU/IM
once or twice a week.
Leukocytospermia these condition
indicate genital tract infection need
prolong case of antibiotic generally
doxycycline, erythromycin, norfloxacin,
4-6 wks.
Erectile dysfunction: Medications such
as sildenafil (25-100mg) & tadalafil (10-
20 mg) is currently advised. A single
dose is given orally one hr. before sexual
activity.
Blockage Of The ejaculatory duct
sperm can be extracted directly from the
testicles & injected in the egg in
laboratory.
Retrograde ejaculation sperm can be
taken directly from the bladder and
injected into the egg in laboratory.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
Surgical
When the patient is found to be Azoospermia
and yet testicular biopsy show normal
spermatogenesis, obstruction of vas must be
suspected this should be correct by
microsurgery---
I. Vasovasostomy.
II. Vaso-epididymostomy.
III. Orchidopexy in undescended testes
should be done b/w 2-3 year of age to
have adequate spermatogenesis in
later life.
Management of female infertility.
 For ovulatory dysfunction
To stimulate ovulation. Drug are:
Clomiphene Citrate – 60mg/ml(IV)
HCG injection – 12000 units/vial(IM /
SC)
Metformin: client who do not response to
clomiphene. Especially when client with
PCOS linked to insulin resistance.
FSH: A hormone produced by pituitary.
Control estrogen production by ovaries.
It stimulate ovaries to relese mature egg
follicle.
Ex. Gonal-F, repronex, follistim, ( give
S/C )
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
Human menopausal gonadotropin:
Generally engineered product. Contain
both FSH & LH. In case of absent
ovulation due to pituitary dysfunction.
EX- bravelle, Repronex, & menopur. (
given IM or can be SC).
Bromocreptane:
Stimulate ovulation by inhibiting
production of prolactin.
Prolactin stimulate milk production in
lactating mother.
EX- Perlodel, Cycloset, (given oral or
IV).
Substitution therapy
Tab. Thyroxin 100 mcg(0.1mg) for
hypothyroidism.
surgery
 Laparoscopic ovarian drilling for (Pcos)
 Fimbrioplasty for fimbria adhesions
 Surgical removal of virilizing of
functioning ovarian or adrenal tumors.
ASSISTED REPRODUCTIVE
THERAPY.
ART encompasses all methods used to
achieve pregnancy by artificial or partially,
artificial means.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
Manipulation of gametes & embryo outside
the body for the treatment of infertility.
In ART the process of intercourse is passed
either by (IUI ) or Fertilization of the oocytes
in the laboratory environment As (IVF).

Different technique of ART.

 Intrauterine insemination (IUI)
 In vitro fertilization & embryo transfer
(IVF-ET)
 Gametes intrafallopian transfer (GIFT)
 Zygote intrafallopian transfer (ZIFT)
 Intra cytoplasmic sperm injection
(ICSI).
 Surrogacy.

 Intrauterine insemination (IUI)

Intrauterine insemination (IUI) may be
either artificial insemination husband
(AIH) or artificial insemination donor
(AID). Husband's semen is commonly
used. The purpose of IUI is to bypass the
endocervical canal which is abnormal and
to place increased concentration of motile
sperm as close to the fallopian tubes.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
The indications are
 Male factor anatomical
defect.
 Oligospermia.
 Unexplained infertility.
 Artificial insemination of husband.
When the semen of a husband is used for
insemination, it is called Artificial
insemination of husband.
Indications :-
 Oligospermia
 Hypospadias (congenital anomaly of
penis )
 Un explained infertility.

 Artificial insemination of donar.

When the semen of a donor is used for
insemination , it is called
Artificial insemination donor.
Indications :-
 Rh sensitization of the womb.
 Untreatable Azoospermia.

 In vitro fertilization & embryo transfer

(IVF-ET).
The field of reproductive medicine has
changed forever with the birth of Louise
brown in 1978 by in vitro fertilization and
embryo transfer.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
It is the process by which egg is fertilized out
side the body in-vitro.
Fertilization of the oocytes in the laboratory
conditions.
Women given a oestrogen therapy causing no
ova to mature at the same time
(superovulation).
After them removed from the ovary through a
laparoscope.
The ova are mixed with spermatozoa from her
spouse & incubated in a
Culture medium until a blastocyst is formed.
When the blastocyst is formed, implanted in
the mothers uterus & the pregnancy allowed
to continue normally.
Indication
 Tubal disease or block
 Cervical hostility (mucus is thick &
sticky wont allow sperm pass )
 Unexplained infertility
 Ovarian failure.
 Advanced reproductive age.
 Multiple factors both male & female.

 Gametes intrafallopian transfer (GIFT)

Gamete intrafallopian transfer (GIFT) was
first introduce by asch and his colleagues
in 1984.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
It is more invasive and expensive procedure
then IVF & result seems better than IVF.
GIFT intrafallopian transfer uses mature
ovum are collected from the ovaries.
The eggs are placed into a thin flexible tube
catheter along with the sperm to be used.
The gametes (both egg & sperm) are then
injected into the fallopian tube using a
surgical procedure called laparoscopy.
Indication
 Tubal disease or block
 Cervical hostility (mucus is thick &
sticky wont allow sperm pass )
 Unexplained infertility
 Ovarian failure.
 Advanced reproductive age.
 Multiple factors both male & female.

 Zygote intrafallopian transfer (ZIFT)

Zygote intrafallopian transfer (ZIFT) was first
described by Devroey et al. (1986).
The placement of the zygote (following one
day of in vitro fertilization) into the fallopian
tube can be done either through the abdominal
ostium by laparoscope or through the uterine
ostium under ultrasonic guidance.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
This technique is a suitable alternative of
GIFT when defect lies in the male factor or in
cases of failed GIFT. Results (29-30%) are
similar to that of IVF.
GIFT or ZIFT is avoided when tubal factors
for infertility are present.
The risk of ectopic pregnancy is high for
GIFT and ZIFT compared to IVE.
 Intra cytoplasmic sperm injection
(ICSI).
Intra cytoplasmic sperm injection was first
describe by van steirteghem and his
colleagues in Belgium 1992.
In the (ICSI) process, a tiny needle called a
micropipette, is used to inject a single
sperm into the center of the egg. with either
traditional (IVF) or (ICSI) once fertilization
occurs .
The fertilized egg (now called an embryo)
grows in a laboratory for 1 to 5 days before it
is transferred to the woman uterus (womb).
Indication
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
 Severe Oligospermia.
 Presence of sperm antibody.
 Failure to fertilization in IVF.
 Unexplained infertility.
 Congenital absence of vas.
 Obstruction of efferent duct (male).
 Athenospermia, tetratospermia.

 Surrogacy.
A woman without a functional uterus can be a
mother with the help of ART.
In this procedure of ART (IVF), a fertilized
egg is placed into the uterus of a surrogate
(gestational carrier) but not into "intended
mother“
Indication.
 Irrepairable uterine factor;
 When pregnancy may cause significant
health risks;
 Prior hysterectomy.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
 Women with recurrent unexplained
miscarriage;

7. 5 min. Enumerate the ROLE OF NURSE IN MANAGEMENT Lecture cum What are the role
role of nurse in OF INFERTILITY. discussion of nurse in
infertility  Nurses meet the couple seeking help for infertility
management. treatment of infertility where services are management?
available.
 Nurses have to work diligently to help the
specialist execute treatment plans play an
important role in supporting the patient’s
trough complex journey of infertility
treatment.
 Their role with such couples includes
assessing, educating & counselling in
addition to therapeutic assistance as they
undergo test & procedures.
 It is important for nurse to understand that
men & women are very concerned &
possibly emotionally fragile.
 It is important to meet the couple
together.
 An important steps in evaluation for
infertility is taking a detailed medical &
family history from each partner.
S.NO. TIME SPECIFIC CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVE LEARNING
ACTIVITY
 During therapy the couple need to avoid
smoking, continue good diet , maintain
health & take folic acid supplements if
prescribed.

CONCLUSION
Although infertility is a common both male
and female, the least treatment method and
technique has proven to be effective treatment
method. So, in this topic of infertility, I
explain all the important elements of
Infertility, including types, cause, diagnosis,
management and role of nurse in infertility.
We understand “infertility
is a failure to conceive within one or more
years of unprotected intercourse” we all are
known about the type’s primary & secondary
infertility and its cause they enhance the risk of
infertility.
 BIBLIOGRAPHY.
BOOK REFERANCE.
 Brunner & Siddhartha’s, Textbook of Medical Surgical Nursing, 2ndVolume, 11TH Edition, Published by Walters Kluwer
publication, Page no.-1650-1652.
 Baker, Obstetrics by ten teachers, Eighteenth Edition, Hodder and Stoughton publisher, Revised in 2001, page no. 300-307..
 Dutta D.C, textbook of Gynaecology, 4th edition, published by new central book agency, pg. No – 114-120.
 Daftary N. Shirish, Manual of obstetrics, Third edition, Published by “ A division of reed Elsevier India pvt. LTD, Revised in
2012, page no. 243-272.
 Jacob Annamma, A textbook of midwifery & Gynecological nursing, 6th edition, Jaypee health science publishers, page No –
656-662.
 Kumari Neelam, A textbook of midwifery & Gynecological nursing, 6th edition, Jaypee brothers’ medical publishers, revised
in 2023, Pg. No.-692-694.
 Myles textbook of midwives, 16th edition, revised in 2014, pg. No – 455- 550.
 Malhotra Narendra, Text book of Obstetrics and Gynaecology for Post graduates, fourth Edition, Jaypee Brother medical
Publisher (P) LTD, Revised in 2014, page no.372-380.

ONLINE REFERANCE.

https://www.slideshare.net/NikhilVaishnav3/infertility-143363096
https://www.slideshare.net/ebwhs/infertility-6409342
https://kgmu.org/download/virtualclass/Pathology/Dr Atin Singhai, Pathology Lecture.ppt
https://slideplayer.com/slide/7535598/