Female Infertility

AHN
 Objective
At the end of presention the student will be able To
 Define infertility in women.
 Describe the types of infertility
 Explain Pathophysiology of infertility.
 Discuss the Epidimiology of infertility.
 Discuss the Causes of infertility.
 Enlist Sign and symptoms of infertility
 Indentify Risk factors of infertility
 Explain Medical Managment
 cont....
• Discuss the Diagnosis of Infertility.
• Formulate Nursing diagnosis and
Intervention.
 Infertility Definition
Infertility is “a disease of the reproductive
system defined by the failure to achieve a
clinical pregnancy after 12 months or more
of regular unprotected sexual intercourse.
(WHO)
 Types
1.Primary infertility:
When a woman is unable to bear a child,
either due to the inability to become
pregnant or the inability to carry a
pregnancy to a live birth.
2.Secondary infertility

Those who repeatedly spontaneously

miscarry or whose pregnancy results in a
stillbirth, or following a previous pregnancy
are then not unable to carry a pregnancy to
a live birth would present with secondarily
infertility.
 Pathophysiology
• Pathophysiology varies according to aetiology.

1. Ovulatory dysfunction
2. Hypo-gonadotrophic anovulation occurs as a
result of Hypothalamic or Pituitary abnormalities.
3. Hyper-gonadotrophic anovulation occurs as a
result of Ovarian failure.
4. Polycystic ovarian syndrom
 cont...
5. Fallopian tube problems

 Caused by Gonorrhoea and Chlamydia infection.

 Any pelvic infection, including appendicitis and
diverticulitis(inflammation of a diverticulum, especially in
the colon, causing pain and disturbance of bowel
function) can damage the fallopian tubes.

 The growth of Hormonally responsive endometrial

tissue outside the uterus may cause anatomical
obstruction of the fallopian tubes. It may also lead to
infertility by producing cytokines that may be toxic to
sperm or embryos.
 Epidemiology
• Infertility is a major disease worldwide.
• Globally, the highest incidence of infertility is
found in Central and Southern Africa where as
many as 1 in 3 women are infertile.
• Around 1 in 6 couples in industrialised countries
seek medical advice on infertility.
• In the US, it is estimated that 2.1 million married
couples are affected by infertility.
• In 2002, it was reported that 12% of women had
received infertility services at some time in their
lives.
 cont....
• Female aetiologies are present in 42.2%
of cases,
• male aetiologies in 18.8% of cases,

• combined male and female aetiologies in

17.8% of cases, and
• unexplained aetiology in 13.6% of cases.
 Causes of female Infertility
Female infertility can be also be caused by a
number of factors, including the following:

1.Damage to fallopian tubes(utrine tube).

which carry the eggs from the ovaries to the
uterus when damage can prevent contact between
the egg and sperm.

2.Pelvic infections and pelvic surgeries may lead

to scar formation and fallopian tube damage.
 causes cont...
1.Hormonal causes.
Some women have problems with
ovulation.
hormonal changes leading to the release of
an egg from the ovary and the thickening of
the endometrium (lining of the uterus) in
preparation for the fertilized egg do not
occur.
 Cotn…
4.Cervical causes:
A small group of women may have a
cervical condition in which the sperm cannot
pass through the cervical canal. Whether
due to abnormal mucus production or a prior
cervical surgical procedure.
 Symptoms
The main symptom of infertility is the
inability of a couple to get pregnant.

A menstrual cycle that's too long (35 days

or more), too short (less than 21 days),
irregular or absent can be a sign of lack of
ovulation
 Risk factors
Certain factors may put you at higher risk of
infertility, including:
1.Age:
With increasing age, the quality and
quantity of a woman's eggs begin to decline.
 cont...
2.Smoking:
Besides damaging your cervix and fallopian
tubes, Smoking increases your risk of miscarriage
and Ectopic pregnancy(a pragnancy in which the
fetus develops outside the uterus,typically in a
fallopian tube).
3.Weight:
If you're overweight or significantly
underweight, it may hinder normal ovulation.
 cont...
4. Sexual history:
Sexually transmitted infections such as
chlamydia and gonorrhea can cause
fallopian tube damage.
4.Alcohol:
Heavy drinking is associated with an
increased risk of ovulation disorders and
endometriosis.
 Tests and diagnosis
Ovulation testing:
• A Test that you can perform.
• Detects the surge(increase) in luteinizing
hormone (LH) that occurs before
ovulation.
• A blood test for Progesterone a hormone
produced after ovulation — can document
that you're ovulating.
• Other hormone levels, such as Prolactin,
also may be checked.
 cont...
• Hysterosalpingography:
During hysterosalpingography X-ray
contrast is injected into Uterus and an X-
ray is taken to determine if the uterine
cavity is normal or not.
 cont....
• Laparoscopy:
Laparoscopy may identify endometriosis,
scarring, blockages or irregularities of the
fallopian tubes, and problems with the ovaries
and uterus.
• Genetic testing:
Genetic testing helps determine whether
there's a genetic defect causing infertility
 Prevention
• If you're a woman thinking about getting
pregnant soon or in the future, you may
improve your chances of having normal
fertility if you:
 cont....
• Maintain normal weight
• Quit smoking.
• Avoid alcohol.
• Reduce stress. Some studies have
shown that couples experiencing
psychological stress had poorer results
with infertility treatment
 cont....
• Limit caffeine.
Some physicians suggest limiting
caffeine intake to less than 200 to 300
milligrams a day.
it can cause placenta abnormilities.
 Treatments and drugs
• Treatments can either attempt to restore
fertility
By means of medication or surgery —
 Fertility restoration: Stimulating
ovulation with fertility drugs
• Fertility drugs:
which regulate or induce ovulation, they
work like the natural hormones
Follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) to trigger
ovulation.
 cont....
• Clomiphene citrate: (Clomid, Serophene)
is taken orally and stimulates
ovulation by causing the pituitary gland to
release more FSH and LH, which
stimulate the growth of an ovarian follicle
containing an egg.
 cont....
• Gonadotropins:
these injected treatments stimulate the
ovary directly.
 cont.....
• Bromocriptine: (Parlodel, Cycloset)
may be used when ovulation
problems are caused by excess
production of prolactin
(hyperprolactinemia) by the pituitary gland.
 Nursing diagnosis
• Follipian injury R/L to Infection secondary
to infertility
• Scar formaton in the follipian tube R/T
surgery or injury secondary to infertility
• Deficiency of Progerteron and follical
stimulatin hormons R/t disease secondary
to infertility
 Intrvention
• Administered antibiotic for the treatment of
infection.
• Administered fertility drug to regulate the
fertility
• Educate the women to mantain normal
weight before the pragnancy
• Teach the women to minimize stress and
anxiety which are the cause of infertility
 References
• Practice Committee of the American
Society for Reproductive Medicine.
Smoking and infertility.
• Fertil Steril. 2008;90(suppl 5):S254-
S259Eichener SF, Timpe EM. Urinary-
based ovulation and pregnancy: point-of-
care testing. Ann Pharmacother.
2004;38:325-331..