INFERTILITY
Infertility is defined as the inability to conceive a child after 1 year of regular sexual intercourse
unprotected by contraception
TYPES
1. Primary infertility is defined as the inability to conceive a child after 1 year of regular
sexual intercourse unprotected by contraception
2. Secondary Infertility is the inability to conceive after a previous pregnancy
Cultural Considerations
Infertility is not only a physiologic problem, but is one that can initiate a life crisis that is
experienced with psychological, familial, social, and cultural consequences. Cross-culturally, the
expectation for couples to reproduce is an accepted norm and the inability to conceive may be
considered a violation of this cultural norm
Etiology and Risk Factors
Multiple known and unknown factors affect fertility. Female-factor infertility is detected in about
40% of cases, and male-factor infertility in about 40% of cases. The remaining 20% fall into a
category of combined (both male and female factors) or unexplained infertility. In women,
ovarian dysfunction (40%) and tubal/pelvic pathology (40%) are the primary contributing factors
to infertility
Risk factors for infertility in women include:
Overweight or underweight (can disrupt hormone function)
Hormonal imbalances leading to irregular ovulation
Uterine fibroids
Tubal blockages
Cervical stenosis
Reduced oocyte quality
Chromosomal abnormalities
Congenital anomalies of the uterus
Immune system disorders
Chronic illnesses such as diabetes, thyroid disease, asthma
STIs
Ectopic pregnancy
History of PID
Smoking and alcohol consumption
Multiple miscarriages
Menstrual abnormalities
Exposure to chemotherapeutic agents
Psychological stress
Risk factors for infertility in men include:
Exposure to toxic substances (lead, mercury, x-rays, chemotherapy)
Cigarette or marijuana smoke
Heavy alcohol consumption
Use of prescription drugs for ulcers or psoriasis
Exposure of the genitals to high temperatures (hot tubs or saunas)
Hernia repair
Obesity is associated with decreased sperm quality
Cushing syndrome
Frequent long-distance cycling or running
STIs
Undescended testicles (cryptorchidism)
Mumps after puberty
Diagnosis
Male
1. Semen analysis
2. Blood M/C/S
Female
Assessment of ovarian function
Ovulation predictor kits used midcycle
Urinary LH level
Clomiphene citrate challenge test
Assessment of pelvic organs
Papanicolaou (Pap) smear to rule out cervical cancer or inflammation
Cervical culture to rule out any STIs
Ultrasound to assess pelvic structures
Hysterosalpingography to visualize structural defects
Therapeutic Management
The majority of infertility cases are treated with drugs or surgery. Treatment
options include;
Lifestyle changes, such as weight loss, and smoking cessation; taking clomiphene
to promote ovulation; hormone injections to promote ovulation; intrauterine
insemination; and in vitro fertilization. Various ovulation-enhancement drugs and
timed intercourse might be used for the woman with ovulation problems. The
woman should understand a drugs benefits and side effects before consenting to
take it.
Depending on the type of drug used and the dosage, some women may experience
multiple births. If the woman’s reproductive organs are damaged, surgery can be
done to repair them. Still other couples might opt for the hi-tech approaches of
artificial insemination and egg donation, or they may contract for a gestational
carrier or surrogate
