UNIT 3 fertility And infertility.

Fertility:

When a woman has the ability to conceive and bear children (offspring), it is called fertility. Fertility means the natural capacity to produce offspring is called fertility.

Actors Affecting Fertility in Women:

Generally, five factors that affect a woman’s fertility are:

1) Biological factor,
2) Physiological factor,
3) Social Factor,
4) Economic factor,
5) Family planning.

1) Biological Factors:

Age: A woman’s fertility ability naturally declines with age. The number and quality of eggs decline over time, especially after the age of 35. Older women may also face an increased risk of chromosomal abnormalities and miscarriage.

Hormonal Imbalance:
Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders and irregular hormone levels can disturb ovulation and the menstrual cycle.

Reproductive health issues: Conditions such as endometriosis, which involves the growth of tissue similar to the lining of the uterus outside the uterus, and uterine fibroids, which are non-cancerous growths in the uterus, can impair fertility due to structural issues or hormonal imbalances. can affect

Genetic Factors: Genetic factors such as Turner Syndrome or Fragile X Syndrome can affect reproductive health and fertility.

2) Physiological Factors:

Menstrual cycle regularity: Regular ovulation is important for conception. Irregular cycles and absence of ovulation can affect the ability to conceive.

Body Weight: Both underweight and obesity can affect hormone levels and menstrual cycles. Excess body fat can lead to estrogen imbalance, while low body fat can disrupt the hormonal functions necessary for ovulation.

General Health: Chronic illnesses such as diabetes or autoimmune disorders can affect reproductive health. Additionally, conditions like diabetes can affect hormone levels and overall health, which can affect fertility.

3) Social Factor:

Education and Awareness: Knowledge about reproductive health and fertility can influence a woman’s ability to make decisions about her reproductive health and fertility treatment.

Social support: Supportive networks and access to healthcare professionals can impact the ability to treat and manage fertility issues.
Cultural Attitudes: Cultural beliefs and social norms regarding family size, gender roles, and childbearing can affect fertility decisions and practices.

4) Economic Factor:

Access to Healthcare: Availability and affordability of medical care such as fertility treatments, and diagnostic tests can affect fertility.

Employment and Work Life Balance: Job stress and long working hours can affect general health, hormonal balance and ability to follow fertility treatments.

5) Family Planning:

Developed countries have been able to reduce their fertility rates by voluntarily adopting family planning devices. But in underdeveloped countries both male and female hesitate to use contraceptives due to social taboos and restrictions, ignorance, poverty, illiteracy etc.

These factors can affect the fertility rate.

Infertility

Definition:

Infertility is a medical condition in which there is inability to conceive a pregnancy despite having regular and unprotected intercourse for 1 year or more, then such a condition is called infertility.

It affects approximately 10-15% of couples worldwide. Infertility can be due to various factors affecting male, female or both, and can be temporary or permanent.

Type of Infertility
There are generally two types of infertility.

1) Primary infertility,
2) Secondary infertility

1) Primary Infertility:
It is indicated for patients who have not been able to conceive a single pregnancy.

2) Secondary Infertility:

Thus, prior pregnancy indicating conception but subsequent failure to conceive is called secondary infertility.

Causes of Infertility

There are three main causes of infertility.
1) Fault in female,
2) Fault in Mail,
3) Combined factor.

1)Fault in Female:

A) Ovarian factor:
Ovulatory dysfunction is seen mainly for its three reasons as follows.

a) Anovulation/Oligoovulation:
Anovulation/oligoovulation is usually due to disturbances in the hypothalamopituitaryovarian axis.
Ovarian activity depends on gonadotrophin and normal secretion of gonadotrophin depends on GnRH (gonadotrophin releasing hormone) released from the hypothalamus.

(b) Lutenized unruptured follicle (LUF)
(Trapped Ovum):
This is seen due to inadequate growth and function of the corpus luteum.

(C) Trapped Uvam:
In this, the ovum is trapped inside the follicles, usually due to endometriosis or hyperproductemia.

2) Tubal Factors:
Infertility in this is usually due to tubopathy (tubal infection) due to which tubal functions are impaired.
Ex:= Defective ovum pickup followed by infertility.

3) Peritoneal factor:
One and the main factor of infertility is endometriosis.

4) Uterine factor:
These include certain factors that stop the implantation of the fertilized ovum into the endometrium.
These factors like,
a) Endometriosis,
b) fibroid uterus,
c)Uterine hypoplasia,
d) Congenital malformation of the uterus.

5) Cervical Factors:
In this due to second degree uterine prolapse,
Due to retroverted uterus,
And due to changes in the composition of the cervical nucleus.

6) Vaginal factor:
These include vaginal atresia,
Transverse vaginal septum, due to

2) Fault in Mail:

A) Ovarian factor:
Ovulatory dysfunction is seen mainly for its three reasons as follows.

a) Anovulation/Oligoovulation:
Anovulation/oligoovulation is usually due to disturbances in the hypothalamopituitaryovarian axis.
Ovarian activity depends on gonadotrophin and normal secretion of gonadotrophin depends on GnRH (gonadotrophin releasing hormone) released from the hypothalamus.

(b) Lutenized unruptured follicle (LUF)
(Trapped Ovum):
This is seen due to inadequate growth and function of the corpus luteum.

(C) Trapped Uvam:
In this, the ovum is trapped inside the follicles, usually due to endometriosis or hyperproductemia.

2) Tubal Factors:
Infertility in this is usually due to tubopathy (tubal infection) due to which tubal functions are impaired.
Ex:= Defective ovum pickup followed by infertility.

3) Peritoneal factor:
One and the main factor of infertility is endometriosis.

4) Uterine factor:
These include certain factors that stop the implantation of the fertilized ovum into the endometrium.
These factors like,
a) Endometriosis,
b) fibroid uterus,
c)Uterine hypoplasia,
d) Congenital malformation of the uterus.

5) Cervical Factors:
In this due to second degree uterine prolapse,
Due to retroverted uterus,
And due to changes in the composition of the cervical nucleus.

6) Vaginal factor:
These include vaginal atresia,
Transverse vaginal septum, due to

2) Fault in Mail:

1) Due to defective spermatogenesis:
This leads to infertility and is usually due to the following:
orchitis,
undescended testes,
testicular toxins,
Primary testicular failure,
Due to genetic or chromosomal disorders such as, 47,XXY,
Due to endocrine factors such as thyroid dysfunction.

2) Obstruction of the efferent duct system due to:
These are found in two types.
1) Congenital:
As the vas deferens are absent.
2) Acquired:
This is usually due to some infection,
Occurs due to tuberculosis, gonorrhea, and surgical trauma (during herniorrhaphy).

3) Failure to deposit spam in Wajaina:
This is due to failure to deposit sperm in the vagina.
This is due to:
impotence,
Ejaculatory failure,
hypospadias,
Bladder neck surgery.

4) Due to error in seminal fluid:
Hence, due to immotile sperm,
Due to disturbance in sperm count,
Because of the low fructose count.

3) Combined Factor:
In this, infertility is seen due to the combined factors of both male and female.

Diagnostic Investigation:

Complete history collection and physical examination
This includes assessment of overall health, including reproductive health, history and identification of potential risk factors.

Ovulation Testing:
This includes monitoring the menstrual cycle and properly assessing whether ovulation occurs regularly.

Siemens Analysis:
In this, sperm count is evaluated and sperm size, morphology, and other parameters are assessed.

Imaging Testing:
This includes ultrasonography and hysterosalpingiography to assess the uterus and fallopian tubes.

Hormonal test:
In this, hormonal levels are assessed to assess ovarian factor and other endocrine disorders.

Diagnostic Procedure:
For example, laparoscopy (to examine the affected organ), and genetic testing (to identify chromosomal abnormalities).

Treatment:

Treatment of infertility depends on its cause, duration and duration of infertility.

Lifestyle Modifications:

Weight management
Achieving a healthy Body Mass Index (BMI) through an adequate diet and regular exercise can improve fertility.

Smoking and Alcohol Cessation:
Both smoking and alcohol consumption in excessive amounts have a negative impact on fertility. So it should be avoided.

Stress Reduction:
Yoga, meditation, and counseling techniques help reduce stress and its effects on fertility.

Medication
Fertility drugs are provided to stimulate ovulation in women and improve sperm production and function in men.

Surgery:
Anatomical abnormalities such as tubal blockage, uterine fibroid, and varicocele (enlarged vein in scrotum) are corrected in surgery.

Hormonal therapy

Correcting hormonal imbalances that affect fertility such as thyroid disorders and hyperprolactinemia.

Treatment of infection

If there is an infectious condition like pelvic inflammatory disease (PID) then providing the patient with adequate antibiotic medication to treat the infection that affects fertility.

3) Surgical Intervention:

Laparoscopic surgery
Used to treat conditions that affect fertility, such as endometriosis, pelvic adhesions, and fibroids.

Tubal surgery
Tubal surgery involves repairing a blocked or damaged fallopian tube that prevents sperm from reaching the ovum.

4) Assisted Reproductive Technologies (ART):

Intra Uterine Insemination (IUI):
Intra-uterine insemination is a process to improve fertilization in which sperm are inserted directly into the uterine cavity at the time of ovulation.

In Vitro Fertilization (IVF)
In the in vitro fertilization process, the ovum and sperm are fertilized outside the body i.e. in the laboratory.
In whose step,

Ovarian stimulation
Medications are used that stimulate the ovaries to produce multiple eggs.

Egg retrieval
A surgical procedure for collecting eggs from the ovaries.

Fertilization
Eggs and sperm are mixed in a laboratory dish and then the embryo is cultured.

Embryo transfer
Now more than one embryo is transferred into the uterine CVD.

Intra cytoplasmic injection
In this procedure, sperm are directly injected into the egg to improve fertilization.

General Nursing Management:

To take proper measures to improve the general health of the patient.

If the person is obese, give advice to reduce weight.

Advise the patient to avoid heavy smoking and alcohol.

Advise the patient to award tight and loose undergarments.
Advise the patient to take proper vitamin E, vitamin C, vitamin B12 and folic acid which improves spermatogenesis.

Provide proper psychological support to the patient.

Checking the patient’s body weight properly and calculating the body mass index which
Should be between 20-24.
Advising patients on proper stress management. In which giving advice to the patient to do yoga and meditation properly.