CASE PRESENTATION ON

INFERTILITY
ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY

The reproductive system in men has components abdomen,

pelvis and perineum.

SCROTUM: It is an out pouching of the lower part of the

anterior abdomen wall.

TESTES: Testes is ellipsoid shaped.

 Left testis is usually lying at the lower level than right.

 ANATOMY AND PHYSIOLOGY

EPIDIDYMIS: It is a single long coiled duct that courses along the

posteirolateral side of the testis.

DUCTUS DEFERENS: Also called as Vas Deferens. It is a log

muscular duct that transports spermatozoa from tail of epididymis to

the ejaculatory duct.

SEMINAL VESICLES: These are an accessory gland of the male

reproductive system.
 ANATOMY AND PHYSIOLOGY

EJACULATORY DUCTS: The function is to drain the seminal fluid

into prostatic urethra.

PROSTATE: The prostate is an unpaired accessory structure of the

male reproductive system that surrounds urethra in the pelvic cavity.

PENIS: The penis is a pendulous organ suspended from the front

and side of pubic arch and containing greater part of urethra.

ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY

•The uterus is a hollow, pear shaped muscular organ located in the true pelvis between the bladder and the

rectum.

SHAPE AND SIZE:

•It’s pear shaped, being flattened anterio-posteriorly.

MEASUREMENTS:

Length- 3 inches (7.5cm)



Breadth- 2 inches (5cm)



Thickness- 1 inches (2.5cm)



Weight- 50 to 80 grams

 DEFINATION

Infertility is defined as, “ Failure to conceive within one or more

years of regular unprotected coitus.”

Primary Infertility: Those patients who have never conceived

is denoted as primary infertility.

Secondary Infertility: Those patients who have conceived but

fails to conceive subsequently is denoted as secondary infertility.

 FACTORS REQUIRED FOR FERTILIZATION
(Male & Female)

 Healthy spermatozoa should be deposited high in the vagina at or near the

cervix.

 Capacitation and acrosome reaction spermatozoa should undergo changes and

acquire motility in cervical canal.

 MOTILITY: Spermatozoa should ascend through the cervix into the uterine

cavity and fallopian tube.

 OVULATION: Ovum should reach the fimbriated end of the tube.

 Patent Fallopian tube: Fertilization should occur at the ampulla of the tube.

 Transportation of the fertilized ovum to the uterus cavity in 3-4 days the

fertilized ovum should reach the uterine cavity for nidation.

 CAUSES
(Male Factors )

1. Faults in male
 Defective Spermatogenesis
 Obstruction of efferent duct system
 Failure to deposit sperm high in the
vagina
 Errors in the seminal fluid
 CONGENITAL: Undecended testes

Kartagener syndrome

Hypospadiasis
 CAUSES
(Male Factors )

 THERMAL FACTORS:

Scrotal temperature is raised in conditions such as varicocele

 INFECTION: - Mumps orchitis

- T. mycoplasma or Chlamydia trachomatis infection is also impacted

 GENERAL FACTORS:

- Chronic debilitating disease malnutrition or heavy smoking reduces

spermatogenesis.

-Alcoholism
 CAUSES
(Male Factors )

 ENDOCRINE: Testicular failure

( Kallmann’s Syndrome)

 GENETIC: - Chromosomal Abnormality

- Klinefelter’s Syndrome

 IATROGENIC: - Radiation,

- cytotoxic drugs

- Nitrofurantoin, cimetidine, beta blockers,

anti hypertensive, anti convulsant drugs

 IMMUNOLOGICAL: Anti bodies against

spermatozoal surface antigens maybe cause

of infertility.
 CAUSES
( Female Factors )

OVARIAN FACTORS

1) Anovulation or oligo-ovulation:

Disturbance in hormones can cause anovulation,

oligomenorrhoea or amenorrhea

2) Tubal and peritoneal factors: - Peritubal adhesions

 Endosalpingeal damage

 Previous tubal surgery

 Salpingitis

 Tubal or peritoneal endometriosis

 Polyps within the lumen

 Tubal spasm
 CAUSES
(Female Factors)

•UTERINE FACTORS:
 CAUSES
(Female Factors)

•CERVICAL FACTORS:
 CAUSES
(Female Factors)

VAGINAL FACTORS:


Atresia

Septum

Narrow introitus

COMBINED FACTORS:


Age beyond 35 years ( female )

Infrequent intercourse

Apareunia

Anxiety

Use of lubricant during intercourse which maybe spermicidal

Immunological factors
 INVESTIGATIONS
(Male)

History

Routine Investigations

Semen Analysis

Testicular Biopsy

Transrectal Ultrasound

Immunological Test
 INVESTIGATIONS
(Female)


History

Physical Examinations


Routine Examinations


Endometrial Biopsy


Sonography


Laparoscopy


Insufflation Test ( Rubin’s test)



Hysterosalpingography


Laparoscopic & Chromotubation



Sonosalphingography


Hysteroscopy

 MANAGEMENT OF MALE INFERTILITY

1) General Care:

a) Improvement of general health

 Reduction of weight in obese

 Avoidance of heavy smoking and alcoholism

 Avoidance of tight and warm undergarments

 Avoidance of occupation that may elevate testicular temperature

b) Avoiding medications that interfere with spermatogenesis such as cytotoxic

drugs , Nitrofurantoin, cimetidine, anticonvulsants, antidepressants and beta

blockers.
 MANAGEMENT OF MALE INFERTILITY

2) Medications to treat specific causes:

a)Human Chorionic gonadotropin (hCG) and Human Menopausal

gonadotropin (hMG) for hypogonad

b) Dopamine agonist (cabergoline) for hyperprolactinemia and altered

testosterone level and to improve libido potency and fertility

c) The GnRH therapy for hypogonadism

d) Clomiphene citrate to increase serum levels of FSH, LH and testosterone

e) Antibiotics for genital tract infections

 MANAGEMENT OF MALE INFERTILITY

3) Special treatments for causes identified such as

a)Intrauterine insemination (IUI)

b)In Vitro fertilization (IVF)

c)Intracytoplasmic sperm injection (ICSI)

d)Artificial insemination with donor (AID) sperm

4) Surgical treatment:

e)In men whose testicular biopsy shows normal spermatogenesis and obstruction is

suspected, vasoepididymostomy or vasovasostomy may help

f)Correction of hydrocele
 MANAGEMENT OF FEMALE INFERTILITY

1) For ovulatory dysfunction:

a) Induction of ovulation using drugs such as Clomiphene citrate,

Letrozole, FSH, hCG and GnRH

b) Correction of biochemical abnormality, Metformin for

hyperinsulinemia, Dexamethasone for androgen excess,

bromocriptine for prolactin excess.

c) Substitution therapy : Thyroxin for hyperthyroidism , antidiabetic

drugs for DM
 MANAGEMENT OF FEMALE INFERTILITY

2) Surgery:

a) Laparoscopic ovarian drilling (LOD) or laser vaporization for Polycystic Ovarian

Syndrome (PCOS)

b) Surgical removal of virilizing or functioning ovarian or adrenal tumor

c) Tubotubal anasthomosis for adhesion in tube.

d) Cannulation and ballontuboplasty for block in the tube

e) Fimbrioplasty for fimbrial adhesion

f) Adhesiolysis for separation or division of adhesion

g) Salpingostomy to create an opening in the tube in a completely occluded tube

MANAGEMENT OF FEMALE INFERTILITY

h) Surgical removal of ovarian or adrenal tumor

i) Uterovaginal Surgery
j) Bariatric Surgery
 TREATMENT

 ARTIFICIAL INSEMINATION:

 Intrauterine Insemination (IUI)

 Fallopian Tube Sperm Infusion
 ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

 In Vitro Fertilization and Embryo transfer (IVF-ET)

 Gamete Intrafallopian Transfer (GIFT)
 Zygote Intrafallopian Transfer (ZIFT)
 MICROMANIPULATION

 Intracytoplasmic Sperm Injection (ICSI)

 Embryo or Oocyte Donation
 Gestational Carrier Surrogacy
 NURSING MANAGEMENT

When a couple presents with concerns about infertility, it is

important for nurse to understand that men and women are

very concerned and possibly emotional.

Nursing interventions include assisting in reducing stress in

the relationship encouraging co operation, privacy and

understanding.
 COMPLICATIONS

Relationship Problems


Depression


Stress


Ovarian Hyperstimulation Syndrome



Ectopic Pregnancy


Pelvic Infection


Multiple Pregnancy


Miscarriage


Side effects of medications


 HEALTH EDUCATION

LIFESTYLE MODIFICATION:
1.Alcohol: Consumption of alcohol affects the chances of

conception in both males and females

2.Smoking: Active or passive smoking while trying to conceive can

cause barrier in process.

3.Body Weight: Overweight or underweight of any partner should

be adequately dealt with to obtain equal optimal body weight.

BMI>30decreases fertility.
 HEALTH EDUCATION

4. Folic Acid Supplementation: It helps to decrease the birth defects

and improve sperm count. Eat green-leafy vegetables, citrus, beans ,
etc
5. Ideal Coital Frequency: Intercourse on alternate days during fertile
period increases chances of pregnancy

6. Avoid stress