May 18, 2015

NURS 330Human Reproductive Health

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

INFERTILITY

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

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

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

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

Chances of Pregnancy by Age

Age Fertility %

Up until 34 90%

By age 40 Declining to 67%

By age 45 Declining to 15%

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

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

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

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

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).

PID (cont)• Causes of PID• Untreated/uncured bacterial infection

• Most common chlamydia (about 75% of cases)• Second most common cause is gonorrhea.

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

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

Endometriosis and infertility• Endometrial cysts in the fallopian tubes may cause blockage

• Scar tissue between uterus, ovaries and fallopian tubes

• Poor egg implantation

Female Infertility-Other possible causes • Hormone Disorders• Hypothalamic-Pituitary Disorders• Polycystic Ovarian Disease/Syndrome• Thyroid• Other

• Ovarian Cysts• Ectopic pregnancies, medical conditions,

medications

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

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

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

Varicocele• 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

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

Testing for Infertility – females• Ovulation Assessment• Body temperature• Cervical mucus assessment

• Hormone Analysis • Laparascopy• Check vagina for naturally occurring sperm antibodies

Infertility Treatment• Artificial Insemination• Drug therapy• Clomid

• In Vitro Fertilization (IVF)

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

• BREAK

• GROUP PRESENTATIONS