Maternal 2 (Lecture)

Infertility

Infertility
• This is a condition where pregnancy doesn’t – Varicocele
happen after at least a year of unprotected coitus. o Varicosity of the spermatic vein

Types of Infertility:
Primary Infertility
– There has been no previous conception at all
Secondary Infertility – Trauma
– There has been a previous viable pregnancy but – Surgery on or near the testicles that has resulted
the couple is unable to conceive at present. in impaired testicular circulation
– Endocrine imbalances, particularly of the thyroid,
pancreas, or pituitary glands
Sterility – Drug use or excessive alcohol use
• Inability to conceive because of unknown – Environmental factors, such as exposure to X-rays
or radioactive substances
condition like absence of the uterus

Subfertility
• Lessened ability to conceive.

Male Infertility Factors

• Problem in spermatogenesis (inadequate sperm
Obstruction or Impaired Sperm Motility
count).
• May occur at any point along the pathway that
• Inadequate production of FSH and LH in the
spermatozoa must travel to reach the outside:
pituitary, which stimulates the production of
seminiferous tubules, the epididymis, vas
sperm
deferens, ejaculatory duct or the urethra.
• Obstruction in seminiferous tubules, ducts or
vessels. Preventing the continuous moving of the
sperm.
• Qualitative or quantitative changes in the seminal Conditions Associated with the Sperm Motility
fluid preventing sperm motility. Mumps Orchitis
• Development of autoimmunity, which immobilizes ▪ Testicular inflammation and scarring due to
sperm the mumps virus
• Problems in ejaculation or deposition

Inadequate Sperm Count

• This is the total number of sperm cell in a single
ejaculation or in a milliliter or semen.
• Normal sperm count is 33 million to 46 million per
mL of seminal fluid or 50 million per ejaculation. Epididymitis
• 50% should be motile and 30% should be in ▪ Inflammation of the epididymis
normal shape and form.

Reasons:
– Cryptorchidism
o Undescended testes

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 Hypospadias Ejaculatory Problem
▪ Urethral opening on the ventral surface of the
penis
Erectile Dysfunction (Formerly known as IMPOTENCE)
– Inability to achieve an erection
– May be due to psychological problems and some
debilitating diseases
– Examples of debilitating diseases:
o Cerebrovascular accident
o Parkinson’s Disease
o Use of medications that causes erectile
dysfunction
o Antipsychiatric medication
o Antihypertensive medication
Epispadias o Antiparkinson’s medication
▪ Urethral opening on the dorsal surface o Chemotherapeutic medications

Premature Ejaculation (Ejaculation before penetration)

– Another factor that may interfere with the proper
deposition of sperm.
– Attributed to psychological causes.

Female Infertility
• Anovulation (faulty or inadequate production of
ova).
• Problems of ova transport through the fallopian
tubes to the uterus)
• Uterine factors like presence of tumors or poor
endometrial development
• Cervical and vaginal factors (that immobilizes the
spermatozoa)
• Poor nutrition, increased body weight, and lack of
exercise

Anovulation
• Absence of ovulation or release of ova from the
Peyronie Disease ovary
▪ A bent penis • May be due to genetic abnormality as Turner’s
▪ Can cause sperm to be deposited too far from syndrome (hypogonadism)
the sexual partner’s cervix to allow optimal • hormonal imbalance (hypothyroidism)
cervical penetration • Ovarian tumors or polycystic ovary syndrome
• Chronic or excessive exposure to X-rays or
radioactive substances
• General ill health, poor diet, and stress

Tubal Transport Problems

• May be due to scarring of the fallopian tubes
secondary to PID

Extreme Obesity in a Male

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 • Emotional needs quality of the relationship.
• Spontaneity in relationship is stressed.
• Clients may experience guilt, shame, loss, and
depression.
• Promote appropriate resources and accurate
information
• Adoption may be a possibility for this couple.

Uterine Problems
• Poor secretion of estrogen or progesterone from
the ovary may result in inadequate endometrium
formation.
• Conditions like endometriosis (abnormal growth
of endometrial cells outside the uterus) may also
interfere with the uterine fertility
• Congenital Anomalies of the uterus

Cervical and Vaginal Problem

• Presence of infection may affect the environment
that could affect the motility of the sperm.
• The characteristics of the cervical mucus if it is
capable of being penetrated by the sperm.

Diagnostic Tests for Infertility

Male Diagnostic Test

– Sperm analysis
o Volume of ejaculate
o Viscosity
o pH
– Testicular ultrasound

Female Diagnostic Test

– Cervical mucus test
– Pelvic ultrasound
– Hormonal test
– Hysterosalpingogram
– Hysteroscopy

Management
• Financial, physical, and emotional resources are
affected.

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