Infertilityseminarppt 190718134710
Infertilityseminarppt 190718134710
SCIENCES THRISSUR
OBSTETRICS AND
GYAECOLOGICAL NURSING
INFERTILITY
PRESENTED BY:
SUBITHA BABU
JOSCO COLLEGE OF
NURSING EDAPPON
OBJECTIVES:
General objectives:
At the end of the seminar student
will have in-depth knowledge
regarding infertility, its causes and
diagnostic evaluation and its
management.
Specific objectives:
At the end of the seminar student will able
to:
Define infertility
Explain the types of infertility
Factors required for fertility in male and
female
Explain the causes of male and female
infertility
Identify diagnostic tests of infertility
Explain the management of male and
female infertility and also the management
of unexplained infertility
Discuss the role of nurse in management
of infertility
INTRODUCTION
15 %
40 %
MALE FACTORS THAT CAUSES
INFERTILITY
• Defective spermatogenesis
• Obstruction of the efferent ducts
• Failure to deposit sperm
• Errors in seminal fluid
Defective spermatogenesis
H. Genetic: Common
chromosomal abnormality in
azoospermic male is Klinefelter’s
syndrome (47, XXY).
Defective spermatogenesis
J. Immunological factor:
Antibiotics against spermatozoa
surface antigens may cause
infertility. This causes clumping of
spermatozoa after ejaculation.
Obstruction of the efferent ducts:
pH 7.2-7.8
HISTORY
EXAMINATION
DIAGNOSTIC EVALUATION
HISTORY
TAKING
MARRAIGE
MENSTRUAL
PREVIOUS OBSTETRIC
CONTRACEPTIVE PRACTICE
SEXUAL PROBLEMS
Examinations
General examination: Obesity,
abnormal distribution of hair and
underdevelopment of secondary
sex characteristics.
Systemic examination:
Hypertension, organic heart
disease, endocrinopathies.
Examinations
Gynecologic examination: Evidence
of vaginal infection, undue
elongation of cervix, uterine size,
position, nodules in the pouch of
Douglass.
Speculum examination: For
presence of cervical discharge,
which if present needs to be tested
for infection.
DIAGNOSTIC EVALUATION
Menstrual history: Look for
evidences of ovulation such
as:
Regular, normal menstrual loss
between the ages of 20 and 35.
Mid-menstrual bleeding (spotting)
or pain, or excessive vaginal
discharge suggestive of
mittelschmerz syndrome.
Features of primary dysmenorrheal
or premenstrual syndrome (PMS)
Diagnostic evaluation
Cervical mucus study:
Disappearance of fern pattern of the
mucus beyond 22nd day of cycle,
progesterone causes dissolution of
sodium crystals. Following
ovulation, there is a loss of
stretchability or elasticity is an
evidence of ovulation. Fern test
during the cycle aids in determining
ovulation.
Diagnostic evaluation
Endometrial biopsy
Diagnostic evaluation
Laparoscopy: Laparoscopic
visualization of recent corpus luteum
or detection of the ovum from the
aspirated peritoneal fluid to the
pouch of Douglas is the direct
evidence to ovulation.
Diagnostic evaluation
Insufflation test (Rubin’s test):
It is done to see the patency
of fallopian tubes. It is done by
pushing air or carbon dioxide
under-pressure through the cervical
canal. If the tubes are patent, air
reaches the peritoneal cavity. It is
done in the postmenstrual period at
least 2 days after stoppage of
menstrual bleeding.
Diagnostic evaluation
Rubin’s test Positive
findings include:
Fall in the pressure when
raised beyond 120mm Hg.
Hissing sound heard on
auscultation on either iliac
fossa.
Shoulder pain experienced
by the patient due to irritation of
diaphragm by air.
Diagnostic evaluation
Sonosalpingography
MANAGEMENT OF
INFERTILITY
Management of infertility or
subfertility would depend upon the
causes identified, duration and age
of
the couple, especially the female.
GENERAL
INSTRUCTIONS
Body weight: Overweight or
underweight of any partner should
be adequately dealt with to obtain
an optimal body weight.
Smoking and alcohol: Excess
smoking or alcohol consumption
to be avoided.
GENERAL
INSTRUCTIONS
Ideal coital frequency: Intercourse
on multiple days during the fertile
window period, which includes the
five preceding and the day of
anticipated ovulation, should be
reviewed with the couple.
GENERAL
INSTRUCTIONS
Use of at home ‘fertility monitor’
and checking of vaginal mucus
discharge to determine the optimal
timing of intercourse may be most
helpful.
GENERAL INSTRUCTIONS
Use of LH surge kit: Use of the kit
can detect LH surge in urine by
getting a deep blue color of dipstick.
The test performed between 12th and
16th day of regular cycle and timed
intercourse over 24-36 hours after
the color change reasonably
succeeds to conception.
GENERAL
INSTRUCTIONS
Avoidance of lubricants and
douches to be stressed.
The use of fertility impairing
medications should be avoided
by both partners if possible, e.g.
hormones.
GENERAL
INSTRUCTIONS
Psychological support should be
offered as the couple may face
significant stress and sadness as
the investigations and
consultations progress.
MANAGEMENT OF
MALE
1. GeneralINFERTILITY
care:
Improvement of general
health:
•Reduction of weight in obese
•Avoidance of alcohol and heavy
smoking
•Avoidance of tight and warm
undergarments
•Avoidance of occupation that may
elevate testicular temperature
1. General care:
Avoiding medications that
interfere with
spermatogenesis such as:
• Cytotoxic drugs, anticonvulsants,
antidepressants and beta blockers.
2. Medications to treat specific
causes:
Human chorionic gonadotropin
(hCG)
Dopamine agonist (cabergoline) for
hyperprolactinemia and altered
testosterone level and to improve
libido, potency and fertility.
2. Medications to treat specific
causes:
The GnRH therapy for
hypogonadism.
Clomiphene citrate to increases
serum levels of FSH, LH and
testosterone.
Antibiotics for genital tract
infections.
3.Surgical treatment: