Reproductive Health NursingNUR 324 INFERTILITY Lecture 7
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
TYPES OF INFERTILITY 1- PRIMARY : When there is no previous conceptions 20% 2- SECONDARY : When there has been a previous viable pregnancy but the couple is unable to conceive at present 80%
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.
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.
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
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
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
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
MANAGEMENT OF INFERTILITY Correction of underlying problem: Sperm count & motility. Presence of infection. Hormone Therapy. Surgery: e.g Fibroid Tumor Myomectomy
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 MANAGEMENT OF INFERTILITY
Social and Psychological Implications Related to Infertility Psychological reactions Guilt Isolation Depression Stress on the relationship Cultural and religious considerations Slide 13
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.