CLINICAL MANEFISTATION IN INFERTILITY

A medical sign is an objective indication of a sign or characteristic that may be detected during
the physical examination of a patient. These signs can be detectable by anyone, e.g. the
temperature or blood pressure of the patient, skin that is redder than usual or tenderness on
the skin.

 According to a recent survey conducted last 2013, 1 out of 10 Filipinos are infertile;
while another study by the World Health Organization (WHO) declared that the
infertility rate in the country was at 7.90% back in 2004.
 In 2019, fertility rate for Philippines was 2.53 children per woman. Over the last 50
years, fertility rate of Philippines was declining at a moderating rate to shrink from 6.26
children per woman in 1970 to 2.53 children per woman in 2019.
Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with
no success. Female infertility, male infertility or a combination of the two affects millions of
couples.Infertility results from female factors about one-third of the time and male factors
about one-third of the time. The cause is either unknown or a combination of male and female
factors in the remaining cases.

What are risk factors for infertility?

A risk factor is something that makes a person more likely to develop a condition. Some risk
factors, such as age, cannot be changed. Other risk factors, such as lifestyle choices, can be
changed.Many of the risk factors for both male and female infertility are the same. They include:

 Age: Women's fertility gradually declines with age, especially in the mid-30s, and it
drops rapidly after age 37. Infertility in older women is likely due to the lower number
and quality of eggs, and can also be due to health problems that affect fertility. Men over
age 40 may be less fertile than younger men.
 Tobacco and alcohol use: The use of tobacco or alcohol by either a woman or a man
lessens the chance of achieving a pregnancy. It also has a negative impact on how
effective fertility treatments are.Smoking also reduces the possible effectiveness of
fertility treatment. Women who smoke have a higher rate of miscarriages and tubal
pregnancies. Tobacco use can result in a low sperm count in men.

For women, there's no safe level of alcohol use during conception or pregnancy. Alcohol
use may contribute to infertility. For men, heavy alcohol use can decrease sperm count
and motility.
  Body weight: The chance of infertility is increased if a person does not lead an active
lifestyle, is overweight, or is too thin. In men who are above their ideal weight, sperm
counts and testosterone levels may be lower. Women are also at risk of fertility
problems if they have an eating disorder like anorexia or bulimia or if they follow a very
low calorie or very restrictive diet.
 Exercise: Not enough exercise contributes to obesity, which increases the risk of
infertility. In less common cases, frequent exercise that is strenuous and intense can
affect a woman’s ovulation patterns. This can lead to a lack of menstrual cycles (monthly
periods).
 Irregular periods: Irregular menstrual cycles are more common in women who are
underweight or overweight. It is important to try to achieve a normal weight via healthy
lifestyle changes, and see a gynecologist.
 History of sexually transmitted infection: Condoms can help preserve future fertility by
preventing infections, especially with new partners. Also, talk with your partner about
being tested for sexually transmitted infections prior to becoming sexually intimate.

Causes of Infertility

All of the steps during ovulation and fertilization need to happen correctly in order to get
pregnant. Sometimes the issues that cause infertility in couples are present at birth, and
sometimes they develop later in life.
Causes of male infertility

These may include:

 Abnormal sperm production or function due to undescended testicles, genetic defects,

health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps
or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
 Problems with the delivery of sperm due to sexual problems, such as premature
ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as
a blockage in the testicle; or damage or injury to the reproductive organs.
 Overexposure to certain environmental factors, such as pesticides and other chemicals,
and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking
medications to treat bacterial infections, high blood pressure and depression also can
affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise body
temperature and may affect sperm production.
 Damage related to cancer and its treatment, including radiation or chemotherapy.
Treatment for cancer can impair sperm production, sometimes severely.
Causes of female infertility

These may include:

 Ovulation disorders, which affect the release of eggs from the ovaries. These include
hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition
in which you have too much prolactin — the hormone that stimulates breast milk
production — also may interfere with ovulation. Either too much thyroid hormone
(hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause
infertility. Other underlying causes may include too much exercise, eating disorders or
tumors.
 Uterine or cervical abnormalities, including abnormalities with the cervix, polyps in the
uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall
(uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping a
fertilized egg from implanting in the uterus.
 Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube
(salpingitis). This can result from pelvic inflammatory disease, which is usually caused by
a sexually transmitted infection, endometriosis or adhesions.
 Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may
affect the function of the ovaries, uterus and fallopian tubes.
 Primary ovarian insufficiency (early menopause), when the ovaries stop working and
menstruation ends before age 40. Although the cause is often unknown, certain factors
are associated with early menopause, including immune system diseases, certain
genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, and
radiation or chemotherapy treatment.
 Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic
infection, appendicitis, endometriosis or abdominal or pelvic surgery.
 Cancer and its treatment. Certain cancers — particularly reproductive cancers — often
impair female fertility. Both radiation and chemotherapy may affect fertility.
Signs of Potential Infertility in Women

In women, changes in the menstrual cycle and ovulation may be a symptom of a disease related
to infertility. Symptoms include:

 Abnormal periods. Bleeding is heavier or lighter than usual.

 Irregular periods. The number of days in between each period varies each month.
 No periods. You have never had a period, or periods suddenly stop.
 Painful periods. Back pain, pelvic pain, and cramping may happen.

Sometimes, female infertility is related to a hormone problem. In this case, symptoms can also
include:

 Skin changes, including more acne

 Changes in sex drive and desire
 Dark hair growth on the lips, chest, and chin
 Loss of hair or thinning hair
 Weight gain

Other symptoms of disorders that may lead to infertility include:

 Milky white discharge from nipples unrelated to breastfeeding

 Pain during sex

Signs of Potential Infertility in Men

Infertility symptoms in men can be vague. They may go unnoticed until a man tries to have a
baby.
Although most men with male infertility do not notice symptoms other than the inability to
conceive a child, signs and symptoms associated with male infertility include:
 Problems with sexual function — for example, difficulty with ejaculation or small
volumes of fluid ejaculated, reduced sexual desire, or difficulty maintaining an erection
(erectile dysfunction)
 Pain, swelling or a lump in the testicle area
 Recurrent respiratory infections
 Inability to smell
 Abnormal breast growth (gynecomastia)
 Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
 A lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or
a total sperm count of less than 39 million per ejaculate)
References

 https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-
causes/syc-20354308?page=0&citems=10
 https://www.webmd.com/infertility-and-reproduction/guide/understanding-infertility-
symptoms#1
 https://www.medicalnewstoday.com/articles/323401

 Pillitteri, Adele. Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing Family. Wolters Kluwer Health, 2015.
 American Society for Reproductive Medicine. (2002). Frequently asked questions about
infertility. Retrieved October 1, 2002, from http://www.asrm.org