CONTENTS

1. Introduction
2. Defination
3. Type
 Primary
 Secondary
4. Incidence
5. Signs
6. Cause
 Male
 Female
7. Investigation
8. Treatment
 Male
 Female
9. Prognosis
[Link] concept
[Link] according to Ayurveda
[Link]
Introduction to Infertility
Not everyone has the goal of becoming a parent, but for those who do, being
unable to conceive a child is an exquisitely painful reality. Many of us spend a
portion of our lives attempting to avoid unplanned pregnancies, and assume that
once we are ready to conceive, it will happen with little difficulty.

We think that shifting gears from preventing pregnancy to planning conception and
childbirth will proceed in a relatively smooth and orderly fashion. A failure to
conceive, then, is a major life stress, which can break relation of well-adjusted
couples.

Even in today's society, we tend to assume that individuals in committed

relationships have the goal of procreation. Woman are often identified with
their ability to give birth. Both men and women are supposed to pass on their
genetic and generational legacies. Failure by either party to "fulfill their end of
the bargain" can be devastating, humiliating, and emotionally destructive.

Even though tremendous strides have been made in treating this relatively common
condition, infertility is typically not openly discussed.

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)

• Infertility is an inability of a sexually active, non-contracepting couple to achieve pregnancy

in one year.

Types of Infertility:

[Link] Infertility
Primary infertility is infertility in a couple who have never had a child.
[Link] Infertility
Secondary infertility is failure to conceive following a previous pregnancy.
 INFERTILITY

PRIMARY SECONDARY

Those patients who have never conceived indicates previous pregnancy but failure to

conceive subsequently

INCIDENCE
• 80% of couple achieve conception if they do so desire,within one year of having regular
intercourse of adequate frequency (4-5times in a week)
• 10% will achieve the objective by the end of second year
• Remaining 10% will remain infertile by the end of second year

IMPACT OF AGE ON FERTILITY

• Infertility is an unpleasant reality for many patients wishing to conceive. Approxima

1 couple in 7, aged 30-34, will have difficulty conceiving, and this number increases a
function of parental age. The decline in female fertility with advancing maternal has become
an even more pertinent issue in recent years due to social trends. A great number of women
are joining the workforce and participating in higher education, which has led to later mean
ages of first marriages. Consequently, more than 20% of women are delaying childbirth until
after the age of 35.
 Common Signs of Infertility in Men

1. Changes in sexual desire

2. Testicle pain or swelling

3. Problems maintaining erection

4. Issues with ejaculation

5. Small, firm testicles

CAUSES OF MALE INFERTILITY

PRETESTICULAR TESTICULAR POST TESTICULAR

 GENETIC  kartagener  obstruction of efferent duct
a. Y chromosome syndrome a. congenital
deletion  cryptorchidism
I. cystic fibrois
b. Single gene  infections
II. young’s syndrome
mutations  toxins:
 ENDOCRINE drugs,smoking b. acquired infection

a. Ganadotrophi n
 varicocele I. tuberculosis
deficiency  immunologic II. gonorrhea
b. Thyroid  sertoli cell c. surgical
dysfunction syndrome
 primary
I. herniorrhaphy
 PSYCHOSEXUAL
testicular II. vasectomy
a. Erectile failure
dysfunction
 others
b. Impotence
i ejaculatory failure
 DRUGS
ii retrograde ejaculation
a. Antihyperten iii bladder’ s neck surgery
sives
b. antipsychotic
 Common Signs of Infertility in Women
1. Irregular periods
2. Dysmenorrhea or heavy periods
3. Amenorrhea
4. Symptoms of hormone fluctuations
5. Perinea

CAUSES OF FEMALE INFERTILITY

OVARIAN FACTORS (30-40%)
• Anovulation or oligo-ovulation
• Luteal phase defect: In this ,there is inadequate growth and function of corpus
luteum. The lifespan of corpus luteum is shortened to less than 10 days. As a result,
there is inadequate secretory changes in endometrium that will hinders the
implantation
• Decreased ovarian reserve
• Lutenized unruptred follicular syndrome
TUBAL FACTOR (23-30%)
a. Obstruction of tube due to: o Pelvic
infections o Previous tubal
surgery o Salpingitis isthcmia
nodosa o Tubal endometriosis o
Polyps o Tubal spasm

PERITONEAL FACTOR
• Peritubal adhesions
• Minimal endometriosis
UTERINE FACTORS
• Hypoplasia
• Inadequate secretory endometrium
• Fibroid uterus
• Endometritis
• Uterine synechiae
• Congential malformations of uterus
CERVICAL FACTORS
• Anatomic defects preventing sperm ascent due to congenital elongation of the
cervix and second degree uterine prolapsed
• Physiologically,the cervical mucus may be scanty following,amputation ,
conization ,or deep cauterization of the cervix.
• Presence of antisperm or sperm immobilizing antibodies may be implicated as
immunological factor of infertility.
 VAGINAL FACTORS
• Atresia of vagina
• Transversal vaginal septum
• Septate vagina
• Dyspareunia
COMBINED FACTORS
 Presence of factors both in male and female partners causing
infertility
 Infrequent intercourse
 Advanced age of wife beyond 35 years but male spermatogensis
continues throughout life although aging reduces the fertility in
males too.
 Apareunia
 Anxiety
 Apprehension
 Use of lubricants during intercourse
 Immunological factors.

INVESTIGATIONS OF MALE INFERTILITY

History collection

Examination

Investigation:

• Routine investigation
•Seminal fluid analysis
In selected cases, biochemical tests of creatine phosphokinase and reactive oxygen
species are done as sperm function test

In depth evaluation:

• Serum FSH , LH, testosterone , prolactin

• Testicular biopsy
• Karyotyping and genetic testing
• Immunological tests

INVESTIGATIONS IN FEMALE INFERTILITY:

[Link]

• General medical history

• Surgical history
 • Menstrual history
• Previous obstretic history
• Contraceptive problem
• Sexual problem

2. EXAMINATION

• General examination
• Systemic examination
• Gynecological examination
• Speculum examination

[Link] OF OVULTION

1. INDIRECT:
Menstrual history
Sonography
Evaluation of peripheral or endogenous changes:

o BBT (basal body temperature )

o Cervical mucus study o Vaginal cytology o Endometrial biopsy
o Hormone estimation: serum progesterone , serum LH , urine LH
2. DIRECT : laparoscopy
3. CONCLUSIVE : pregnancy

Why is pineapple the symbol of

infertility?

The theory is that pineapple (especially

the core) contains something called
bromelain. Bromelain is an enzyme
that helps us break down and digest our
food. When taken on an empty stomach,
bromelain can act as a blood thinner
and an anti-inflammatory, and all of this
may help an embryo implant into the
uterus.

Orange colour:
The color orange has symbolized fertility since ancient
times. Created by combining red (love) and yellow
(happiness), it's an uplifting, hopeful color. It also stands
 out, which we feel is especially important, since infertility is
often a private disease.

TREATMENT OF MALE INFERTILITY

GENERAL CARE

• Improvement of general health , reduction of body weight in obese , avoidance of

alcohol and heavy smoking ,
• Avoidance of tight and warm undergarments
• Avoidance of occupation that will elevate testicular temperature
• Use of vitamin B12,C,D,E, and folic acid and antioxidants to improve spermatogensis
• Medication that interfers with spermatogensis should be avoided  In
HYPOGONADOTROPHIC HYPOGONADISM :

 HCG 500 IU - IM given twice or once in a week to stimulate endogenous

testosterone production
 HCG +Hmg – when there is no sperm production
 CLOMIPHENE CITRATE ,- 25 to 50 mg daily, for 25 days , with rest of 5 days for 3 cycles is
given. It will increase the serum level of FSH,LH and testosterone
 For GENITAL TRACT INFECTION – give antibiotics like doxycycline or erythromycin for 4-6
week
 In RETROGRADE EJACULATION -- phenylephrine is given
 In TERATOSPERMIA ,ASTHENOSPERMIA –no treatment is given but donor insemination will
be a option
 In GENETIC ABNORMALITIES – artificial insemination with donor insemination

SURGICAL

 Vasovasostomy
 Hydrocele is treated with surgery
 Orchidopexy in undecended testes should be done b/w 2-3 of age

IMPOTENCY

 Psycosexual treatment
 For erectile dysfunction,- sildenafil 25-100mg is currently advised

TREATMENT OF FEMALE INFERTILITY

1. OVULATORY DYSFUNCTION & ANOVULATION:
a. Induction of ovulation :

 GENERAL: psychotherapy , reduction of weight in

obesity
 DRUGS: Stimulation of ovulation-  Clomiphene citrate
  Letrozole (to induce ovulation in women who cannot
ovulate or to help produce multiple eggs in women who
already ovulate on their own.)
 Hmg (FSH75 IU+LH 75 IU)  FSH- Purified urinary FSH
Recombinant LH
Recombinant FSH
 gnRH

b. Correction of biochemical abnormality

 Hyperinsulinemia: Metformin
 Androgen excess: dexamethasone
 Prolactin raised: dopamine agonist

c. Substitution therapy

 Hypothyroidism : thyroxin
 Diabetes mellitus : antidiabitic drug
 Congenital adrenal hyperplasia : corticosteroid

d. Monitoring during ovulation induction :BBT Recording

 LUTEAL PHASE DEFECT
 Natural progesterone as vaginal suppositories 100 mg thrice daily starting
from the day of ovulation is effective
 hCG is a potent luteotrophic hormone
 in unresponsive cases , CLOMIPHENE CITRATE should be tried. It increases
FSH.
 LUTEINIZED UNRUPTURED FOLLICLE
 hCG 5000-10000 IU
 administration of ovulation inducing drugs in the follicular phase followed
by ovulatory hCG
 Bromocriptine therapy

 SURGERY
 Laproscopic ovarian drilling or laser vaporization : it is done by multiple
puncture of the cysts in polycystic ovarian syndrome by diathermy or laser.

 BENEFITS: Risks of OHSS and multiple pregnancy are reduced

 DISADVANTAGE: excessive destruction of ovarian cortex may cause
premature ovarian failure
 COMPLICATIONS: adhesion formations , premature ovarian failure
 Surgery for pituitary prolactinomas
 Surgical removal of virilizing or other functioning ovarian or adrenal tumor
 Uterovaginal surgery
 Bariatric surgery
2. TUBAL or PERITONEAL FACTOR
It can be corrected only by surgery
NAME DESCRIPTION
Adhesolysis(salpingoovariolysis) Separation or division of adhesions
Fimbrioplasty Separation of the fimbrial adhesions to open
up the abdominal ostium

Salpingostomy To create a new tubal opening in an occluded

tube
Tubotubal anastomosis When a segment of diseased tube or
following tubectomy operation is resected
and end to end enastomosis is done

Tubocornual anastomosis When there is corneal block, then the

remaining tube is anastomosed to the patient
interstitial part of the tube

3. ENDOMETRIOSIS and CERVICAL FACTORS

Treated with drugs and surgery both
In CERVICAL FACTORS;

 Conjugated ostrogen 1.25 mg daily starting on 8 day for five days – to improve the
cervical mucus quality
 In proved cases,[Link] doxycyline 100mg twice daily for 14 days is to be given to
both the partners
 Do ART procedures like IUI,IVF or GIFT – in untreated cases

4. IMMUNOLOGICAL FACTORS
 In presence of antisperm antibodies in the cervical mucus – dexamethazone 0.5mg
at bed time in the follicular phase
 In antisperm antibody positive patients , COH , IUI, IVF, ICSI is recommended
5. UTEROVAGINAL SURGERY
 Myomectomy
 Metroplasty
 Adhesiolysis with insertion of IUCD
 Enlargement of vaginal inroitus (Fenton’s operation)
6. UNEXPLAINED INFERTILITY
Recommended treatment are:

 Induction of ovulation
  Superovulation combined with IUI and ART
 The fault detectedin partners should be treated simultaneously

ASSISTED REPRODUCTIVE TECHNOLOGIES

It comprises all the procedures that involves the manipulation of gametes
and embryos outside the body for the treatment of infertility Different Methods of
ART:
IVF-ET In vitro fertilization and embryo transfer
GIFT Gamete intra fallopian transfer
ZIFT Zygote intrafallopian transfer
POST Peritoneal oocyte and sperm transfer
PROST Pronuclear stage tubal tranfer
TET Tubal embryo transfer zone
SUZI Subzonal insemination
ICSI Intracytoplasmic sperm injection
AH Assisted hatching
IVM In vitro maturation of oocyte

SPERM RETRIEVAL TECHNIQUES

TESE Testicular sperm extraction
MESA Microsurgical epididymal sperm aspiration
PESA Percutaneous epididymal sperm aspiration

PROGNOSIS
The pregnancy rate within 2 years after the start of investigation, ranges b/w 30-40%
However rate is increased by 72% when repeated cycles of ART procedures are included
Adoption is the alternative method for many couples.

Conclusion
Infertility means not being able to become pregnant after
a year of trying. If a woman can get pregnant but keeps
having miscarriages or stillbirths, that's also called infertility.
Infertility is fairly common. After one year of having
unprotected sex, about 15% of couples are unable to get
pregnant.
social meanings of reproduction phenomena are constructed differently
depending on the given sociopolitical context. Local and global political
tendencies as well as different social hierarchies have an impact on the
reproductive health of populations and individuals. Gender, race, and nation
mediate individuals' power, personal agency, and choices relating to their
reproductive health . Genetic endowment and the physical and social
environments (for example, environmental pollutants and occupational
exposures) also affect the reproductive health of both women and men. There
are various medical procedures that may increase a person's fertility and
enable the birth of a wanted child. But emotionally and economically the best
solution for infertility is the prevention of infertility at different levels of
everyday life.