The Infertile Couple

Maribee T. Espiritu, RN, MD

Quiz #3
Inability to conceive a child or sustain a pregnancy to childbirth 2. Pregnancy has not occurred after at least _____ of engaging in unprotected sexual intercourse 3. no previous conception 4. previous viable pregnancy but couple is unable to conceive at present
1.

5. inability to conceive because of a known condition, such as the absence of the uterus. 6. lessened ability to conceive 7. undescended testes 8. Instillation of sperm into the female reproductive tract to aid conception. 9. One or more mature oocytes are removed from a woman¶s ovary by laparoscopy & fertilized by exposure to sperm under laboratory conditions outside the woman¶s body.

10. Oocyte retrieval by transvaginal, ultrasound-guided aspiration followed by culture & insemination of the oocytes in the laboratory

Infertility  Inability to conceive a child or sustain a pregnancy to childbirth  Pregnancy has not occurred after at least 1 year of engaging in unprotected sexual intercourse  Affects 14% of couples desiring children .

such as the absence of the uterus. Subfertility ± lessened ability to conceive .Definition of terms     Primary infertility ± no previous conception Secondary infertility ± previous viable pregnancy but couple is unable to conceive at present Sterility ± inability to conceive because of a known condition.

ducts or vessels Qualitative or quantitative changes in the seminal fluid preventing sperm motility Development of autoimmunity that immobilizes sperm Problems of ejaculation or deposition .Male Infertility Factors      Disturbance in spermatogenesis (sperm cell production) Obstruction in the seminiferous tubules.

30%normal in shape & form Spermatozoa must be produced & maintained at a temperature slightly lower than body temperature. . away from the body surface.Inadequate sperm count      Sperm count is the number of sperm in a single ejaculation or in a milliliter of semen. This is the reason why the testes is suspended in the scrotum. Minimum considered normal ± 20m/ml or 50m/ejaculation At least 50% is motile.

Conditions affecting the sperm count       CRYPTORCHIDISM ± undescended testes VARICOCELE ± varicosity of the spermatic vein Trauma to the testes Surgery endocrine imbalance drug use & excessive alcohol intake .

Obstruction or impaired sperm motility   May occur at any point Adhesions & occlusions produced by ± ± ± mumps orchitis epididymitis tubal infections (gonorrhea) .

Other conditions affecting motility      Congenital stricture of spermatic duct BPH Autoimmunization after vasectomy Penile anomalies like HYPOSPADIA (urethral opening on the ventral surface of the penis) or EPISPADIAS (dorsal surface) Extreme obesity in male affecting penetration & deposition .

Ejaculation Problems     Psychological problems Debilitating disease such as Parkinson¶s disease or CVA Medications (anti-HPN drugs) ERECTILE DYSFUNCTION Primary ± never achieve erection & ejaculation Secondary ± has experienced ejaculation in the past but now has difficulty Sildenafil (Viagra) ± drug of choice .

Female Infertility Factors  ANOVULATION ± ± most common cause of infertility in women May result from hormonal imbalance. eventually LH & FSH PCOS ± ovaries fail to respond to FSH .    Ovarian tumors may produce such d/t feedback stimulation on the pituitary. Stress affects by hypothalamic secretion of GnRH.

may lead to pelvic peritonitis PID usuallt begins with cervical infection that spreads by surface invasion along the endometrium and then out to the FT & ovaries.Tubal transport problems    Scarring of the fallopian tube often caused by PID or salphingitis PID ± infection of the pelvic organs . .

or nodules that have spread from the interior of the uterus to locations outside .Uterine problems    Tumors Congenitally deformed uterine cavity Endometriosis ± Implantation of uterine endometrium.

Cervical problems   cervical mucus Polyp obstructing the cervical os .

Vaginal problems  Infection that may affect the vaginal pH may limit or destroy the motility of the sperm .

drug or tobacco use Congenital health problems Current illnesses Menstrual history Contraceptive use Pregnancies or abortions .Fertility Assessment Health history         General health Nutrition Alcohol.

Physical assessment  Secondary sex characteristics  Genital abnormalities  Breast and thyroid examination .

Fertility Assessment Fertility Testing .

dry specimen jar examined within 1 hour Number. appearance & motility is noted Test may be repeated after 2-3 months .Semen Analysis      After 2-4 days of sexual abstinenc ejaculates by masturbation into a clean.

once it reaches the ovum will efectively penetrate.Sperm penetration Assay & antisperm Antibody testing  To determine whether a man¶s sperm. .

Ovulation monitoring  BBT  Ovulation  Assesses by test strip upsurge of LH that occurs before ovulation .

 Hysterosalpingography   Radiologic exam of fallopian tubes radiopaque medium most commonly used to assess tubal patency .Tubal Patency  Sonohysterography   Ultrasound to inspect uterus inspect the uterus for abnormalities  septal deviation or mass.

Advanced Surgical Procedures .

Endometrium resembles a corkscrew ± ovulation has occurred done 2 or 3 days before the expected menstrual flow .Uterine Endometrial Biopsy    Used as a test for ovulation or to reveal an endometrial problem such as luteal phase defect.

Hysterosalphingogram .

Contraindications   Suspected pregnancy Presence of infection Caution that spotting may occur  .

hollow tube. through the cervix.Hysteroscopy   Visual inspection of the uterus through the insertion of a hysteroscope. Helpful when uterine adhesions are discovered previously . a thin.

follicular phase of a menstrual period and is done under GA . hollow. just under the umbilicus examine the position and state of the FT & ovaries. lighted tube through a small incision in the abdomen.Laparoscopy    Introduction of a thin.

Infertility Management Correction of underlying problem Increasing sperm count and motility by abstinence of 7-10 days to count the presence of infection Hormone therapy ± Clomiphene Citrate Surgery .Myomectomy Reducing .

Assisted Reproductive Techniques .

CRYOPRESERVED (frozen) 1 day after ovulation. sperm is injected   .Artificial insemination  Instillation of sperm into the female reproductive tract to aid conception.

Artificial insemination .

. ova is inserted into the woman¶s uterus where 1 would implant & grow ideally. 40 hrs. after fertilization.In vitro fertilization   One or more mature oocytes are removed from a woman¶s ovary by laparoscopy & fertilized by exposure to sperm under laboratory conditions outside the woman¶s body.

      Used by couples who has not conceived Man with oligospermia Unexplained infertility Donor ovum maybe used Before the procedure. GnRH is given. . ovaries are observed. Hcg is injected causing ovulation 38-42 hours later. When a mature follicle is seen via sonography. 10th day of menstrual cycle.

ovulation Capture of the ova .

Fertilization of ova & growth in culture medium Insertion of fertilized ovum into uterus .

into an open end of a patent FT Contrainidicated in blocked FT as it may lead to ectopic pregnancy .Gamete intrafallopian transfer    Ova obtained as in IVF Both ova & sperm are instilled within a matter hours using a laparoscopic technique.

zygote in the uterus for implantation Differs from GIFT as there is no need for at least a functional FT since it is implanted in the uterus  .Zygote intrafallopian transfer (ZIFT)  Fertilization in the tube.

gonadotrophic hormones are administered .Surrogate embryo transfer    Assisted in women who does not ovulate Donated oocyte Synchronized menstrual cycle of donor & recipient.

THE END SALAMAT ! .

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