INFERTILITY

> is defined as a couples inability to achieve pregnancy after a year of

unprotected intercourse.
> Primarily infertility refers to as a couple who never had a child.
> Secondary infertility means that at least one conception has
occurred, but currently the couple cannot achieve a pregnancy.
> Women’s infertility may be related to anovulation, uterine or cervical
factors, blocked fallopian tubes, or endometriosis, while men’s
infertility is related to sperm quality or sperm production.

PATHOPHYSIOLOGY

Possible cause of infertility includes:

* Uterine displacement by tumors

* Congenital Anomalies
* Inflammation

> For an ovum to become fertilized, the vagina, fallopian tubes, cervix,
uterus must be patent and the mucosal secretions are alkaline,
whereas normal vaginal secretions are acidic. Often more than 1 factor
is responsible for the problem. Identifying the cause may require the
services of a gynecologist, urologist, and endocrinologist.

ASSESSMENT AND DIAGNOSTIC FINDINGS

Evaluation includes physical examination, endocrinologic investigation,

and consideration of psychosocial factors.

* OVARIAN FACTORS

> Determine if there is regular ovulation and if progestational

endometrium is adequate for implantation may include basal body
temperature chart for at least 4 cycles, an endometrial biopsy, serum
progesterone level, and ovulation index. The Ovulation index involves
a urine- stick test that determines if the surge in LH that precedes
follicular rupture has occurred.
* TUBAL FACTORS

> Hysterosalpingography is used to rule out uterine or tubal

abnormalities. Laparoscopy permits direct visualization of the tubes
and other pelvic structures and can assist in identifying conditions that
may interfere with infertility.

* CERVICAL FACTORS

> The cervical mucus can be examined at ovulation and after

intercourse to determine whether proper changes occur that promote
sperm penetration and survival. A post coital cervical mucus is
performed @ 2- 8 hrs after intercourse. Cervical mucus is aspirated
with a medicine dropper-like instrument. Aspirated material is placed
on a slide and examined under a microscope. For presence and
viability of the sperm cells. The woman is instructed not to bathe or
douche between coitus and the examination.

* UTERINE FACTORS

Fibroids, Polyps, and congenital malformation are possible condition in

this category. Their presence may be determined by pelvic
examination, hysteroscopy, saline sonogram and
hysterosalpinography.

MEDICAL MANAGEMENT

* PHARMACOLOGIC THERAPHY

> Pharmacologically induced ovulation is undertaken when women do

not ovulate on their own or ovulate irregularly. Various medications
are used, depending on their primary cause of infertility.

1. Clomiphene ( CLOMID) – is used when the hypothalamus is not

stimulating the pituitary gland to release FSH and LH. This
medication stimulates follicles in the ovary. It is usually taken 5
days beginning on the 5th day of menstrual cycle. Ovulation
should occur 4-8 days after the last dose.
2. Menotrophin (PERGONAL) – a combination of FSH and LH, used
for women with deficiencies in these hormones. Pergonal
stimulates the ovaries, so monitoring by ultrasound and
hormone levels is essential because over stimulation may occur.
3. Urofollitropin (METRODIN) – contains FSH with a small amount
of LH, is used in some disorders to stimulate follicle growth.
Clomid is then used to stimulate ovulation.
4. Chorionic Gonadotropin – used to stimulate release of the egg
from the ovary and may be used in combination with the above
medications.

* ARTIFICIAL INSEMINATION

> Depositing semen into the female genital tract by artificial

means. If the sperm cannot penetrate the cervical canal normally,
Artificial insemination using the partner’s semen may be
considered.
> Indication for using artificial insemination includes:

1. The man’s inability to deposit semen in the vagina, which may

be due to premature ejaculation, pronounced hypospadias. Or
dyspareunia.
2. Inability of semen to be transported from the vagina to the
uterine cavity.
3. A single woman’s desire to have a child.

* IN VITRO FERTILIZATION

> involves ovarian stimulation, egg retrieval, fertilization and

embryo transfer. This procedure is accomplished by first stimulating
the ovary to produce multiple eggs or ova, usually with
medications, because success rates are greater with more than just
1 early embryo. Many different protocols exist for inducing
ovulation with one or ore agents. Patients are carefully selected and
evaluated, and cycles are carefully monitored using ultrasound and
estraidol levels. At the appropriate time the ova is recovered by
transvaginal ultrasound retrieval. Sperms and eggs are concubated
for up to 36 hrs. And the embryos are transferred about 48hrs after
retrieval. Implantation should occur in 3-5 days.
NURSING MANAGEMENT

> Assist in reducing stress in relationship, encourage cooperation,

protect privacy, foster understanding, and refer couple to
appropriate resources if necessary.
> Because infertility workups is expensive, time consuming,
invasive, stressful and not always successful, couples need support
in working together to deal with this endeavor.
> Smoking is strongly discourages because it has an adverse effect
on the success of assisted reproduction.
> Diet, exercise, stress and reduction techniques, health
maintenance, and disease prevention are being emphasized in
many infertility programs.
 A
Project
In

Pathophysiology

“ INFERTILITY ”

Submitted to: Dra. Ajoc

Submitted by: Tarhata L. Atilano

BSN III - E