Infertility My

8/4/2019 Infertility My

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Infertility

Monisha ManiappanIst year Msc.N

KVM CON


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Definitions

Infertility

Infertility is defined as a failure to conceive

within one or more years of regular unpro-tected coitus.

Fertility

Ability to conceive

Fecundity

Physiological ability to reproduce


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THE ROLE OF UTERUS IN

REPRODUCTION

THE ROLE OF THE CERVIX IN

REPRODUCTION


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Statistics

80% of couples will conceive within 1 year

of unprotected intercourse

~86% will conceive within 2 years ~14-20% of US couples are infertile by

definition (~3 million couples)


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Factors responsible for fertility

are :

Healthy spermatozoa should be deposited high

in the vagina

The spermatozoa remain healthy and penetrateinto the uterine cavity

The ovum finds its way into the uterine tube

where it can be fertilized by a spermatozoon.

The fertilized ovum migrates into the uterusand the endometrium must be in a state,

suitable for the nidation and subsequent

development.


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CAUSES OF INFERTILITY
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PHYSIOLOGICAL

PATHOLOGICAL

HORMONAL

Hypothalamus

Pituitary gland

Thyroid gland

Adrenal problems

Ovaries
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FAULTS IN THE MALE

Defective spermatogenesis

Obstruction of the efferent duct system

Failureto deposit sperm high in the vagina

Errors in the seminal fluid
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Defective spermatogenesis
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causes of defective

spermatogenesis are :

Congenital Undescended testes

Kartagener syndrome

Hypospadias

Thermal factor

varicocele, big hydro cele or

filariasis
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Infection

(a) Mumps orchitis

(b) The quality of the sperm is adversely

affected by chronic systemic illness likebronchiectasis and obesity. Bacterial or

viral infection of the seminal vesicle or

prostate depresses the sperm count, (c) T. mycoplasma or Chlamydia

trachomatis infection is also implicated.

(d)venereal disease or tuberculosis


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General factors Chronic debilitating

diseases, malnutrition or heavy smoking

reduce spermatogenesis Endocrinal-

Kallmann's syndrome

Hyperprolactinemia

Genetic -

Klinefelter's syndrome (47 XXY)
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Iatrogenic

Radiation, cytotoxic drugs, nitrofurantoin,

cimetidine, antihypertensive, anticonvulsantand antidepressant drugs are likely to hinder

spermatogenisis

Immunological factor
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Obstruction of the efferent ducts

efferent ducts may be obstructed by

infection like tubercular, gonococcal

surgical trauma (herniorrhaphy orhydrocele operation).

In Young's syndrome there is epididymal

obstruction and bronchiectasis.
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Failure to deposit sperm high in

the ' vagina (coital problems)

Impotency

Ejaculatory defect - premature, retrograde

or absence of ejaculation Hypospadias

Sperm abnormality Loss of sperm

motility (asthenozoospermia), abnormalsperm morphology (round headed sperm,

teratozoospermia).
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Errors in the seminal fluid

Unusually high or low volume of ejaculate

Low fructose content

High prostaglandin content

Undue viscosity


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FAULTS IN THE FEMALE

tubal and peritoneal factors (36-44 per

cent),

ovulatory factor (26-44 per cent) and endometriosis (1-10 per cent).


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Ovarian factors :

Anovulation or oligo-ovulation

Luteal phase defect (LPD)

Luteinised unruptured follicle (LUF)


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Causes of Luteal Phase Defect

Poor follicle production occurs in the first

half of the cycle

Premature failure of the corpus luteum Failure of the uterine lining to respond

Luteinised unruptured follicular syndrome


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Tubal factors

impaired tubal function (tubopathy)

includes

defective ovum pick up (octopus function),impaired tubal motility,

loss of cilia and

partial to complete obstruction of the tuballumen
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ENDOMETRIOSIS


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Peritoneal factors


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Uterine factors

uterine hypoplasia,

inadequate secretory endometrium,

fibroid uterus,

endometritis (tubercular in particular),

uterine synechiae

congenital malformation of uterus whichinclude unicornuate uterus,bicornuate,

didelphys etc
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Uterine muscle problems
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Cervical factors

Anatomic

congenital elongation of the cervix.

second degree uterine prolapse .

acute retroverted uterus.

. Pin hole os
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Physiologic

composition of the cervical mucus

excessive, viscous or purulent discharge as in

chronic cervicitis . Presence of antisperm or sperm immobilizing

antibodies


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(1)There is not enough mucus for the sperm to

survive.

2) The mucus is too thick for sperm to survive.

3) The mucus contains sperm antibodies.
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. Vaginal factors

Atresia vagina (partial or complete),

transverse vaginal septum,

septate vagina

narrow introitus causing dyspareunia

Vaginitis and purulent discharge


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Surgical Complications

Scar tissue left after abdominal surgery can

cause problems in the movement of the

ovaries, fallopian tubes, and uterus,resulting in infertility

Frequent abortions


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Illness

Diabetes

kidney disease

high blood pressure

Ectopic pregnancy and

urinary tract infections


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Medications

hormones

Antibiotics

antidepressants

analgesics


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Premature Menopause


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Combined factors

General factors :

Infrequent intercourse

Apareunia and dyspareunia

Anxiety and apprehension

Use of lubricants during intercourse .

Immunological factors


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Sexually transmitted infections

Life style factors

Heavy alcohol consumption

Obesity

supply of estrogen from the peripheral

source


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Genetic conditions

Environmental factors

toxic chemicals,

excessive heat ,

air pollution and heat.


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Unexplained infertility


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The Emotional Effects of

Infertility on the Couple

Relationship

Sexual tension:

Financial stress:

Fear of abandonment:

Arguments about treatments:

suggestions to help both partners during


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suggestions to help both partners duringthe infertility process:

Communicate openly with each other.

Realize there's no right or wrong way to feel

Ask partner what she/he needs rather thanassuming that the other can/cannot give it.

Recognize the psychological and emotional

differences between men and women.

See if each other can teachsome of the skills

learned from own life experiences as man or

woman.

Share more in the process of treatment..
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Documents

Infertility My