Infertility

Group D

By: Eleanor Ahlstrom, Nicole Arreaga, Julia Binder, Riley Ford,

Carla Hernandez, Jocelyne Maldonado, Bella Rahal, Leah
Skromme, & Sarah Soderberg
What is Infertility?
● Infertility involves the reproductive system that prevents the
conception of a child.
● After one year of attempting to conceive a child without success, the
diagnosis of infertility is typically given to the couple.
(American Pregnancy Association, 2019)
What is Primary Infertility?
● Primary Infertility:
○ A couple that has unsuccessfully conceived a child
(American Pregnancy Association, 2019)
What is Secondary Infertility?
● Secondary Infertility:
○ A couple that has previously
become pregnant, however
infertility then occurs.
○ Regardless of previous outcome.
○ Primary infertility is more common
than secondary infertility.
(American Pregnancy Association, 2019)
Infertility in the U.S.
● Infertility affects 6.1 million women in U.S. (10%)
(Office of Women's Health, 2018)

● Rates of infertility have decreased in the U.S.

● Most consumers believe infertility rate is rising due to the increased
talk of infertility in the news
Infertility Among Men
Male infertility accounts of 30% of Infertility.
Five reasons a male might be infertile:

1. Hypothalamus or Pituitary Disorder

2. Gonad Disorder
3. Sperm Transport Disorder
4. Sperm Abnormalities
a. Inflammation of testes, swollen veins in scrotum, abnormally developed testicles
5. History of Sexually Transmitted Disease
(American Pregnancy Association, 2019)
Infertility Among Women
Female infertility accounts for 50% of all Infertility

Five reasons a female might be infertile:

1. Hormone Imbalance
2. Tumor or cyst
3. Eating disorders
4. Stress or intense exercise
5. Endometriosis or fibroids
(American Pregnancy Association, 2019)
Evaluation of Female Infertility
Ovarian Reserve Test
● Tests the number and quality of eggs
(oocytes) a woman has
● Ability of eggs to successfully
become fertilized
Laparoscopy/Hysteroscopy
● Assesses for abnormalities in the
reproductive organs
● Done under general anesthesia in a
surgical center
● Laparoscopy- view of the uterus,
ovaries, fallopian tubes, and internal
pelvic area
● Hysteroscopy- view of the inside of the
uterus
(Fertility Associates of
Memphis, 2019)
Evaluation of Male Infertility
Semen Analysis Endocrine Tests
● Volume of sperm ● FSH and LH needed to
● Concentration of produce testosterone
sperm ● Testosterone needed for
● Motility of sperm sperm production and
● Morphology of sperm function

(American College of Obstetricians and Gynecologists, 2017)

Management of Infertility
Pharmacologic Agents: Female Infertility
● Beneficial for infertility due to problems
with ovulation
○ Most medications help stimulate
ovulation
● Least likely to benefit infertility due to
damage to fallopian tubes or severe
endometriosis
(National Institute of Child Health and Human Development
[NICHD], 2017)
Pharmacologic Agents: Female Infertility
● Clomiphene citrate ● Injectable gonadotropins (FSH &
○ Oral pill LH)
○ Taken in the beginning of ○ Prescribed when woman does
menstrual cycle not respond to clomiphene
○ Stimulates release of FSH & ○ Hormones injected directly into
LH → stimulates ovulation in woman to stimulate ovulation
80% of women treated

(National Institute of Child Health and Human

Development [NICHD], 2017)
Pharmacologic Agents: Female Infertility
● Bromocriptine
○ Treats abnormally high levels of hormone prolactin
○ Prolactin can interfere with ovulation
○ Normalizes prolactin levels for 90% of women → 85% women will
ovulate (NICHD, 2017)
● Letrozole
○ Oral pill
○ Decreases amount of estrogen a woman makes → stimulates
ovulation
(National Institute of Child Health and Human
Development [NICHD], 2017)
Pharmacologic Agents: Male Infertility
● Majority of male infertility is idiopathic = more difficult to treat
● Drug therapy beneficial for men with known cause of infertility
● Gonadotropin releasing hormone injections (GnRH)
○ For: men with hypogonadotropic hypogonadism
○ Stimulates release of FSH & LH
○ Induces spermatogenesis in 85% of patients
○ Works in as early as 4 months
(Dabaja & Schlegel, 2014)
 Pharmacologic Agents: Male Infertility
● Gonadotropin injections (FSH &
LH)
○ Introduced if GnRH injections
don’t stimulate
spermatogenesis
○ Spermatogenesis in 80% of
men
○ Treatment lasts 6-24 months
(Dabaja & Schlegel, 2014)
● Cabergoline (dopamine agonist)
○ Men with pituitary tumors (usually
have hyperprolactinemia)
○ Normalizes prolactin levels in 70%
of men
○ Suppresses prolactin secretion →
increased secretion of GnRH →
increased FSH & LH →
spermatogenesis
Artificial Insemination (AI)
● Alternative method used after failure of medication therapy, and
other treatments
● Sperm from partner or donor
● Sperm deposited into uterus or cervix by way of a plastic catheter
● Examples of when procedure is done:
a. Decreased cervical mucus production
b. Decreased sperm production
c. Decreased sperm motility
d. Anti-sperm antibodies
(Durham & Chapman, pp. 41-41, 2019)
In Vitro Fertilization (IVF)
● Type of assisted reproductive technology (ART)
● Combining a woman’s egg and a man’s sperm in a laboratory setting
● Why is it performed?
○ When less expensive fertility techniques have failed
○ Advanced maternal age
○ Endometriosis
○ Male factor infertility
○ Damaged or blocked fallopian tubes

(MedlinePlus, 2018a)
In Vitro Fertilization (IVF)
5 steps of IVF:

1. Stimulation (AKA super ovulation)

2. Egg retrieval
3. Insemination and fertilization
4. Embryo culture
5. Embryo transfer
(MedlinePlus, 2018a)
In Vitro Fertilization (IVF)
Risks for IVF:

● Fertility meds: Side effects can include bloating, abdominal pain,

headaches, mood swings, and ovarian hyperstimulation syndrome (OHSS)
● Retrieving eggs can cause bleeding, damage to surrounding ovarian
structures like the bladder, and infection
● Multiple gestation have increased risk for premature birth and low birth
weight
● Costly (MedlinePlus, 2018a)
Gamete Intrafallopian Transfer (GIFT)

1. Eggs are collected from a woman’s ovaries

2. Eggs and sperm are placed into a catheter
3. Gametes injected into fallopian tubes via laparoscopy
Reasons parents choose to use GIFT:
● Beliefs that oppose fertilization occurring outside the human body
● Insurance (Michigan Medicine, 2018)
Gamete Intrafallopian Transfer (GIFT)
● When gametes are placed in fallopian tubes, it is unknown whether
fertilization has occurred
● Costs $15000-20000
● Risks:
○ Multiple births
○ Pelvic infection from laparoscopy
○ Puncture of internal organs from laparoscopy

(Michigan Medicine, 2018)

Zygote Intrafallopian Transfer (ZIFT)
● Female eggs and a semen sample
are obtained similarly to IVF
● Sperm and ovum are mixed to form
a zygote
● Zygote is implanted in the fallopian
tube through laparoscopy
● Increased risk of multiple and
ectopic pregnancies
(Tanveer, Malviya, & Yadav, 2018)
Other Assisted Reproductive Techniques

Intracytoplasmic Injection
● Similar process to IVF - difference in how
fertilization occurs
● Sperm are aspirated directly from testes
● Microinjected into harvested eggs of
female partner
● Used for men without a vas deferens, low
sperm count, or abnormal sperm motility
(Durham & Chapman, 2019)
Other Assisted Reproductive Techniques

Surrogacy Gestational Carrier

● A separate woman is ● Woman’s fertilized egg is
impregnated with the partner’s placed in the uterus of another
sperm and carries the child on woman who carries the child
behalf of the couple
● Option for women without
healthy eggs

(Durham & Chapman, 2019)

Psychosocial Responses to Infertility: Male & Female
Female:
● Higher levels of distress than males
● Higher levels of clinical depression (similar to women with cancer
or heart disease)
Male:
● Tied to the intensity of the women’s response to infertility
● Marital difficulties greater when the men is infertile
Both:
● Loss of identity
● Increased levels of anxiety compared to the general population
● Feelings of defectiveness and incompetence
● Marital and emotional stress
(Deka & Sarma, 2010)
Question #1
Which of the following is the definition for artificial insemination?

A. Alternative method used after failure of medication therapy, and other

treatments
B. A separate woman is impregnated with the partner’s sperm and
carries the child on behalf of the couple
C. Woman’s fertilized egg is placed in the uterus of another woman who
carries the child
D. Sperm and ovum are mixed to form a zygote
Question #2

What does morphology refer to when analyzing semen?

A. The motility of the sperm

B. The volume of the sperm
C. The shape of the sperm
D. The concentration of the sperm
References
American Pregnancy Association (2019). What is fertility? Retrieved from https://americanpregnancy.org/infertility/what-is-infertility/

Dabaja, A. A., & Schlegel, P. N. (2014). Medical treatment of male infertility. Translational Andrology and Urology, 3(1), 9–16.

doi:10.3978/j.issn.2223-4683.2014.01.06

Deka, P. K., & Sarma, S. (2010). Psychological aspects of infertility. The British Journal of Medical Practitioners, (30)3.

Durham, R. F., & Chapman, L. L. (2019). Maternal-newborn nursing: The critical components of nursing care (3rd ed.). Philadelphia,

PA: F. A. Davis Company.

Fertility Associates of Memphis. (2019). Female infertility. Retrieved from http://www.fertilitymemphis.com/

MedlinePlus (2018a). In vitro fertilization (IVF). Retrieved from https://medlineplus.gov/ency/article/007279.htm

Medline Plus (2018b). Semen analysis. Retrieved from https://medlineplus.gov/ency/article/003627.htm

References
Michigan Medicine (2018). Gamete and zygote intrafallopian transfer (GIFT and ZIFT) for infertility. Retrieved from

https://www.uofmhealth.org/health-library/hw202763

National Institute of Child Health and Human Development (2017). Fertility treatment for females. Retrieved from

https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/treatments/treatments-women

Office of Women’s Health (2018). Infertility. Retrieved from https://www.womenshealth.gov/a-z-topics/infertility

Tanveer, A., Malviya, N., & Yadav, D. (2018). Omics approaches in in vitro fertilization. In Debmalya, B. & Vasco, A (Eds.), Omics

technologies and bio-engineering (pp. 559-575). Cambridge, MA: Academic Press.

The American College of Obstetricians and Gynecologists (2017). Evaluating infertility. Retrieved from

https://www.acog.org/Patients/FAQs/Evaluating-Infertility

UCLA Health (2019). Semen analysis. Retrieved from http://urology.ucla.edu/mens-clinic/semen-analysis