very useful

2.  Infertility primarily refers to the biological
inability of a person to contribute to
conception. Infertility may also refer to the
state of a woman who is unable to carry a
pregnancy to full term

3.  The WHO defines infertility as follows:
 “ Infertility is the inability to conceive a child. A
couple may be considered infertile if, after two
years of regular sexual intercourse, without
contraception, the woman has not become
pregnant (and there is no other reason, such as
breastfeeding or postpartum amenorrhoea).
Primary infertility is infertility in a couple who
have never had a child. Secondary infertility is
failure to conceive following a previous
pregnancy. Infertility may be caused by
infection in the man or woman, but often there
is no obvious underlying cause.

4. ETIOLOGY -Female factors
Ovarian factors:
Anovulation or
oligoovulation
Luteal phase defect
Luteinised unruptured
follicle

5. Tubal factors:
defective ovum pick up
Impaired tubal mobility
Loss of cilia and partial to
complete obstruction of the tubal
lumen.

6. Peritoneal factors
Peritubal adhesions
Endometritis

7. Uterine factors
Uterine hypoplasia
Inadequate secretory
endometrium
Fibroid uterine synechiae
Congenital malformation of the
uterus

8. Cervical factors:
Anatomic:
Congenital elongation of the cervix
Second degree uterine prolapse
Acute retroverted uterus
Physiological :
Fault in the composition of cervical
mucous
Presence of antisperm or sperm
immobilizing antibodies.

9. Vaginal factors:
Atresia vagina ( partial or
complete)
Transverse vaginal septum
Septate vagina or narrow introitus
causing dysperunia
Vaginitis

10. Male factors
Defective spermetogesis
Undescended testis
Orchitis ( mumps)
Genetic disorders
Testicular toxins ( radiation and drugs)
Endocrinal ( thyroid dysfunction,
gonadotropin defficiency)

11.  Obstruction of efferent duct system
Congenital
Absence of vas defference ( cystic fibrosis)
Young’s syndrome
Acquired
Infective ( tuberculosis, gonorrhoea)
Surgical trauma

12.  Failure to deposit sperm high in the vagina
Impotency
ejaculatory failure
Retrogdrade ejaculation
Hypospadiasis
Bladder neck surgery
Psychosexual
Drug related

13.  Defect in sperm and seminal fluid
Immotile sperm
Oligospermia – sperm count i9s less than 20
million per ml
Polyzoospermia- count is more than 350
million per ml
Azoospermia –no spermatozoa in the sperm
Asthenozoospermia- <50% spermatozoa
having forward progressive movement

14. Necrozoospermia –spermatozoa
less or movement is less.
Teratozoospermia - >70%
spermatozoa with abnormal
morphology
Oligoasthenoteratozoospermia-
disturbance in all three variables.

15. Investigation
The infertile couple must be
investigated one year after of
unprotected sexual intercourse.

16. Male Factor
History of age, duration of marriage
etc.
Routine investigation of urine and
blood
conventional semen analysis
A variety of sperm function tests such
as in vitro mucous penetration test,
hamster egg penetration test and post
coital test.

17. Female factor
History about age, duration of
marriage, general medical
history, surgical
history,menstrual history,
previous obstrtric history,
contraceptive practice and
sexual problems.

18. Examination
General, systemic and
gynaecological examination are
done to detect any abnormality.

19. Assessment of ovulation
Basal body temperature
Mid luteal serum progesterone
Endometrial biopsy
Ultrasound monitoring of
ovulation

20. Tubal factor
Hysterosalpingography
Laparoscopy
Falloscopy
Hysterosonography
Hydrolaparoscopy.

21. Others
The peritoneal factors are assessed by
laparoscopy
The uterine factor by
hysterosalpingography and
hysteroscopy.
Immunological factors are evaluated by
a variety of special tests

22. Treatment
• Infertility can be treated with medicine,
surgery, artificial insemination or assisted
reproductive technology.
– Stimulate ovulation with fertility drugs
• About two-thirds of couples who are
treated for infertility are able to have a
baby.
• In most cases, infertility is treated with
drugs or surgery.

23. Couple instructions
 Assurance
the infertile couple remains psychologically
disturbed right from the beginning. The couple
should be tactfully handled to minimize
psychological upset.
Body weight: BMI of 20-24 is optimum
Smoking and alcohol: excess smoking and alcohol is
to be avoided.
Coital problems: the coital problems should be
carefully evaluated. Advice to have the intercourse
during the mid cycle often gives the result.

24. Male infertility
The treatment of male is indicated in
the following cases
Extreme oligospermia
Azoospermia
Low volume ejaculate
Impotency

25. To improve spermatogenesis : improve
the general health,reduction of weight
in the obese,avoidence of alcohol and
heavy smoking are helpful.
Avoidance of tight and warm
undergarments
Cold scrotal batch atleast twise a day
for 5 mins
Aviodence of too frequent sexual
intercourse.

26.  Vit E, C,B12 and folic acid will improve the
general health.
 Hypogonadotropic-hypogonadism is treated
by:clomiphene citrate 25-50 mg for 25
dayswith the rest of 5 days for 3 cycles.it
increases serum level of LH,FHS AND
tesatosterone.
 hCG IM once or twice week

27. In the presence of antisperm
antibodies , dexamethasone 0.5 mg
daily at bed time may be tried.
Genital tract infection needs
prolonged antibiotic therapy.

28. Surgical
 When the patient is found to be azoospermic and
yet testicular biopsy shows normal
spermatogenesis, obstruction of the vas must be
suspected. This should be corrected by micro-
surgery-vaso epididymostomy or vasovasostomy.
After surgery pregnancy rate is 50%
 The presence of varicocoele is corrected by high
ligation of spermatic vein and the hydrocele by
surgery.

29. Impotency
Hyperprolactenaemia is investigated
and treated
Erectile dysfunction is treated with
sildenafil(viagra)
In unresponsive cases artificial
insemination is thought of.

30. Female infertility
Anovulation must be treated with:
Induction of ovulation by using
following methods:
General
Drugs
surgery

31. General
Improvement of nutrition and
weight mangement

32. Drugs
 STIMULATION OF OVULATION
Clomiphene citrate
FSH
Hcg
GnRH
 REDUCTION OF RAISED LEVEL OF
Androgen-dexamethasone
Prolactine- bromocriptine
Insuline- metformin

33. Substitution therapy
Hypothyroidism- thyroxin
Diabetes- anti diabetic drugs

34. Sugery
 Wedge resection of bilateral ovaries in
PCOS.
 laparoscopic ovarian diathermy and laser
vaporization as an alternative to wedge
resection
 appropriate surgery for pituitary
prolactinomas
 Surgical removal of ovarian and adrenal
tumor.

35. What is ART?
Assisted Reproductive
Technologies:
Fertility therapies where eggs and
sperm are manipulated
Involve surgically removing eggs from
women and combining them with
sperm in the laboratory

36. IVF (in vitro fertilization)and
embryo transfer
is a method in which egg cells are
fertilized by sperm cells outside
the mother’s womb (in vitro). The
resulting embryos are then
transferred back into the uterus.

37. STEPS IN IVF
Follicle suppression
Controlled ovarian hyperstimulation
Aspiration of eggs from follicles
Fertilization, incubation and selection
of embryos
Embryo transfer
Pregnancy test

42. Embryo transfer

43. IUI
 Intrauterine insemination (IUI) is a procedure that
involves placing sperm inside a woman’s uterus to
facilitate fertilization. This fertility treatment does not
involve the manipulation of a woman’s eggs, and
therefore is not considered an assisted reproductive
technology (ART) procedure.

44. When is IUI used?
 IUI is a fertility treatment often selected by couples who have
been trying to conceive for at least one year with no success. IUI
may be selected as a fertility treatment with any of the following
conditions:
 Unexplained infertility
 Low sperm count
 Decreased sperm mobility
 Requirement of donor sperm
 A hostile cervical condition, such as cervical mucus that is too
thick
 Cervical scar tissue from past procedures or endometriosis
 Ejaculation dysfunction
 IUI provides the sperm an advantage by giving it a head start, but
still requires a sperm to reach and fertilize the egg on its own.

45. Fallopian Tube Sperm Perfusion
(FSP)
Fallopian Tube Sperm Perfusion
(FSP) is a relatively recent modification
of IUI in which the insemination will
directly place sperm into the fallopian
tubes

46. AID (artificial insemination by
donor)
 AID (artificial insemination by donor): A
procedure in which a fine catheter (tube) is inserted
through the cervix (the natural opening of the uterus)
into the uterus (the womb) to deposit a sperm sample
from a donor other than the woman's mate directly
into the uterus. The purpose of this procedure is to
achieve fertilization and pregnancy. AID is also called
heterologous insemination. AID is distinguished from
homologous insemination, that is artificial
insemination by husband (AIH).

47. Gamete intra-fallopian transfer
(GIFT)
 With gamete intra-fallopian transfer (GIFT), the
preparation and monitoring of the growth of eggs is
identical to in vitro fertilisation (IVF).
 Instead of the eggs being fertilised “in vitro” in the
laboratory, the healthiest eggs and sperm are placed
together in the woman’s fallopian tubes. Fertilisation
therefore takes place in the body, as it would if
conception had occurred naturally.


48.  GIFT has been used with some success in cases where:
 a couple has unexplained infertility
 the woman’s fallopian tubes aren’t blocked or damaged
 the man has a low sperm count, or there are problems
with the sperm
 there are objections to IVF on religious or other
reasons
 IVF has failed to result in a successful pregnancy.

49. Zygote Intrafallopian Transfer: ZIFT
 ZIFT is an assisted reproductive procedure similar to in
vitro fertilization and embryo transfer, the difference
being that the fertilized embryo is transferred into the
fallopian tube instead of the uterus. Because the
fertilized egg is transferred directly into the tubes, the
procedure is also referred to as tubal embryo transfer
(TET). This procedure can be more successful
than gamete intrafallopian transfer (GIFT) because
your physician has a greater chance of insuring that
the egg is fertilized. The woman must have healthy
tubes for ZIFT to work.

50.  ZIFT is an assisted reproductive procedure which may
be the selected form of treatment for any infertility
problems except the following:
 Tubal blockage
 Significant tubal damage
 An anatomic problem with the uterus, such as severe
intrauterine adhesions
 Sperm that are not able to penetrate an egg

51.  Complications
• Multiple pregnancy
• Ovarian hyperstimulation syndrome(OHSS)
– Ovaries may enlarge and cause pain and bloating
– Higher risk in PCOS women
• Bleeding or infection
• Low birth weight
• Birth defects

52.  Ways to Battle Infertility
• Regular exercise
• Avoid alcohol, tobacco, and narcotics
• Limit caffeine
– No more than 250 mg per day
• Limit medications
• Eat a balanced diet

53. Thank you