1. May 18, 2015 NURS 330 Human Reproductive Health

2. Agenda Review 5/4/15 In-Class Assignment Review Quiz Infertility Lecture Submission of Group Project Brochure/Flyer Group Project Presentations Only students who are present will receive credit for this assignment

3. INFERTILITY

4. Infertility Definition: number of couples who have unprotected intercourse for one year and do not experience a pregnancy 10-15% of American couples are infertile

5. Causes of infertility Both men and women contribute to infertility 90% of cases, cause will be known Each gender contributes 40% Both contribute 10% Remaining 10% of cases, cause remains unknown Males Usually due to sperm defect Females More complex

6. Risk Factors Some common risk factors Age Weight Lifestyle Occupational and Environmental risks Stress and Emotional factors Genetic conditions??

7. Age and Infertility Females As a woman gets older, her chances of fertility declines Menopause Higher risk of chromosomal abnormalities that occur in her eggs More likely to have health problems that may interfere with fertility However, if fertilization occurs, can carry to full term High risk of miscarriage Males Not very clear on its impact of age and fertility in men Age does not appear to impact fertility in males as it does in females. More likely to have health problems that may interfere with fertility

8. Chances of Pregnancy by Age AgeFertility % Up until 3490% By age 40Declining to 67% By age 45Declining to 15%

9. Causes of Female Infertility Aging Disorders of Ovulation Damage of the Fallopian Tubes Uterine Fibroids Endometriosis

10. Aging Fertility begins to decline when a woman is in her mid-30s About 10 years before menopause Decrease in ovarian function Reduction in ovaries Increased chromosomal abnormalities Increase in miscarriages

11. Ovulation Disorders Responsible for approx. 25% of female infertility problems Anovulation Oligoovulation

12. Damage to Fallopian Tubes Pelvic Inflammatory Disease (PID) Most common cause

13. Pelvic Inflammatory Disease (PID) Pelvic Inflammatory Disease, or PID, is the major cause of infertility worldwide. It is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries). Infection of one or both fallopian tubes is known as Salpingitis Symptoms Mostly asymptomatic Fever, chills, pelvic pain (indicating inflammation of the entire pelvic area).

14. PID (cont) Causes of PID Untreated/uncured bacterial infection Most common chlamydia (about 75% of cases) Second most common cause is gonorrhea.

15. Uterine Fibroids Occurs in one in every four or five American women Benign tumors Can cause excessive uterine bleeding and pain Interferes with ovum implantation Compresses the opening of the fallopian tubes

16. Endometriosis Uterine lining grows outside the uterine cavity Lining of the uterus, instead of being expelled into the vagina, is expelled out into the fallopian tubes and implanted in other areas of the pelvis. These implants respond to hormonal changes, slowly increasing in number and size with each menstrual cycle Eventually causes scarring and inflammation Symptoms Some have no symptoms Pain before, during and after the menstrual period Pain during sexual intercourse Spotting (bleeding between periods) Cause is unknown Possible defects in immune system

17. Endometriosis and infertility Endometrial cysts in the fallopian tubes may cause blockage Scar tissue between uterus, ovaries and fallopian tubes Poor egg implantation

18. Female Infertility- Other possible causes Hormone Disorders Hypothalamic-Pituitary Disorders Polycystic Ovarian Disease/Syndrome Thyroid Other Ovarian Cysts Ectopic pregnancies, medical conditions, medications

19. Male Infertility Affect sperm quality and quantity Includes problems with: Sperm production Blockage of sperm-delivery system Presence of antibodies against sperm Testicular injury Anatomic abnormalities Varicocele

20. Male Infertility Over 90% of cases are due to: Low sperm count Poor sperm quality Motility Morphology Both 30 - 40% of cases have an unknown cause

21. What affects sperm count and quality? Environmental and Biologic Factors Lifestyle - Emotional-Smoking -Sexual Issues/Infection-Malnutrition -Substance Abuse-Obesity -Testicular Exposure to overheating Genetic Factors Varicocele

22. Varicose vein in the cord that connects to the testicle. Found in 10-15% of all men Found in 25% - 40% of infertile men Only varicoceles large enough to be felt are reported to affect fertility

23. Other causes of sperm defect Testosterone Deficiencies Autoantibodies Retrograde Ejaculation Physical and Structural abnormalities Cancer and its treatments Infections Other medical conditions Medications

24. Testing for Infertility – females Ovulation Assessment Body temperature Cervical mucus assessment Hormone Analysis Laparascopy Check vagina for naturally occurring sperm antibodies

25. Infertility Treatment Artificial Insemination Drug therapy Clomid In Vitro Fertilization (IVF)

26. Infertility Treatment Gamete Intrafallopian Transfer (GIFT) Both egg and sperm inserted into Fallopian tube Zygote Intrafallopian Transfer (ZIFT) Fertilized outside body and inserted into Fallopian tube Intracytoplasmic Sperm Injection (ICSI) Direct injection of sperm into egg in lab

27. BREAK GROUP PRESENTATIONS