1. Reproductive Health Nursing NUR 324
INFERTILITY
Lecture 7

2. Definition
Pregnant has not occurred after at least 1 year of engaging in unprotected coitus.
Sterility:
Is a lessened ability to conceive.
About 14% of couples in USA are infertile

3. TYPES OF INFERTILITY
1- PRIMARY : When there is no previous conceptions %
2- SECONDARY : When there has been a previous viable pregnancy but the couple is unable to conceive at present %

4. MALE INFERTILITY FACTORS
LECTURE 7
MALE INFERTILITY FACTORS
1- Disturbance in spermatogenesis
2- Obstruction in the seminiferous tubules, ducts or vessels preventing movements of spermatozoa.
3- Qualitative or Quantitative changes in the seminal fluid preventing sperm motility.
4- Problems in ejaculation or deposition preventing spermatozoa from being placed close enough to woman's cervix.
Myxoedema: A disease caused by decreased activity of the thyroid gland in adults and characterized by dry skin, swellings around the lips and nose, mental deterioration, and a subnormal basal metabolic rate.
iatrogenic : Induced in a patient by a physician's activity, manner, or therapy. Used especially of an infection or other complication of treatment.
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5. Causes are as follows in a general scale
Female factor 30%
Male factor 30%
Female and male 30%
Idiopathic 10%
The causes will vary from this general scale according to the locality.

6. In Adequate Sperm Count
The sperm count is the number of sperm in a single ejaculation or in a milliliter of sperm.
Minimum sperm count considered normal is 20 million per milliliter of seminal fluid or 50 million per ejaculation.
At least 50% of sperm should be motile and 30% of sperm should be normal in shape and form

7. FACTORS AFFECTING SPERM
LECTURE 7
FACTORS AFFECTING SPERM
1- Body Temperature.
2- Congenital Abnormalities e.g (undescended testes).
3- Varicocele ( varicosity of the spermatic vein).
4- Trauma to the testes.
5- Drug use
6- Environmental Factors e.g X-Ray
Varicocele : Dilatation of the veins associated with the spermatic cord.
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8. FEMALE INFERTILITY FACTORS
1- Anovulation: ( absence of ovulation) Most Common cause of infertility in women.
2- Tubal transport problems
3- Uterine Problems : e.g Tumors , Uterine malformations
4- Cervical Problems:
Normal Cervical mucus is thin & watery that help sperm to penetrate the cervix when become this mucus too thick difficulty to allow sperm to penetrate to cervix.
Cervix Stenosis.
D&C several times.
5- Vaginal Problems: Infection PH of vaginal secretion
become acidotic destroying the motility of spermatozoa
genetic factors – vaginal obstruction

9. DIAGNOSIS OF INFERTILITY
Semen analysis
Ovulation Monitoring
1- By Recording Basal Body Temperature for at
least 1 month every day each morning
before getting out of bed.
2- Assessing the upsurge of LH that occurs before
ovulation by urine sample using kit.
Tubal Patency :
Ultrasound
X-Ray imaging

10. MANAGEMENT OF INFERTILITY
LECTURE 7
MANAGEMENT OF INFERTILITY
Correction of underlying problem:
Sperm count & motility.
Presence of infection.
Hormone Therapy.
Surgery: e.g Fibroid Tumor
Myomectomy
Myomectomy: is the removal of fibroids (noncancerous tumors) from the wall of the uterus
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11. MANAGEMENT OF INFERTILITY
LECTURE 7
MANAGEMENT OF INFERTILITY
Artificial Insemination:
Instillation of sperm into the female reproductive tract to aid conception
This technique can be done in case of :
1- In adequate amount of sperm count
2- Woman has vaginal or cervical factors
In Vitro Fertilization ( IVF ): This technique used in
Blocked or Damaged fallopian tubes.
Oligospermia or Sperm count
In vitro fertilization (IVF): is a procedure in which eggs (ova) from a woman's ovary are removed. They are fertilized with sperm in a laboratory procedure, and then the fertilized egg (embryo) is returned to the woman's uterus.
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13. Social and Psychological Implications Related to Infertility
LECTURE 7
Social and Psychological Implications Related to Infertility
Psychological reactions
Guilt
Isolation
Depression
Stress on the relationship
Cultural and religious considerations
Slide 13
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14. NURSING MANAGEMENT The Major focus of nursing care are:
LECTURE 7
NURSING MANAGEMENT
The Major focus of nursing care are:
1- Providing support for couple as they undergo diagnosis and their chosen treatment.
2- Therapeutic communication skills.
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