1. Infertility
• Inability to conceive a child or sustain a pregnancy to childbirth
– Pregnancy has not occurred after at least 1 year of engaging in unprotected
sexual intercourse
– Affects 14% of couples desiring children
Types of infertility:
• Primary infertility - refers to a couple who has never established a pregnancy
• Secondary infertility - refers to couple who has conceived previously but are currently
unable to establish a subsequent pregnancy
Male Infertility Factors
• Inadequate sperm count – less than 20million/mm of seminal fluid
Less than 60% are motile
Less than 60% has normal shape and form
Causes: chronic infection
Cryptorchidism
Testicular trauma
Endocrine imbalances
Drug/excessive alcohol use
Exposure to radiation
• Obstruction or impaired sperm motility from:
Mumps orchitis Epididymitis
Gonorrhea Ascending urethral infection
Prostate gland hypertrophy Extreme obesity
Anomamalies of the penis (hypospadias/epispadias)
• Ejaculation problems
Erectile dysfunction (debilitating diseases, pdychological problems,drug side
effect)
Premature ejaculation
Female Infertility Factors
• Cervical problems
– Thick cervical mucus
– Stenotic cervical os
• Vaginal problems
– pH becomes excessively acidic (bec. of Infection)
– Sperm agglutinating antibodies in blood plasma (destroys sperm cells)
• Unexplained infertility
• Anovulation (most common cause of infertility in women may be caused by
– Turner’s syndrome (no ovaries -genetic abnormality)

2. – Hormonal imbalance (hypothyroidism which interferes with hypothalamus-
pituitary-ovarian interaction)
– Polycystic ovarian syndrome (no response to FSH)
– Exposure to radiation
– Predisposing factors: stress, decreased body weight, poor diet, general ill health
Fertility Assessment
• Semen Analysis
– Assessment of the number, appearance, motility, and penetration of sperms
• count: 20 million / ml or 50 million /ejaculation
• volume: 2.5ml - 6 ml
• Motility: >75%
• Quality of motion: graded 1-4 (poor to excellent)
• Morphology: more than 70% normal
• Ovulation Monitoring
– Record basal body temperature
– Ovulation by test strip
 Assesses upsurge of LH that occurs before ovulation
Tubal Patency
– Sonohysterography
 Ultrasound to inspect uterus
– Hysterosalpingography
 Radiologic exam of fallopian tubes
Advanced Surgical Procedures
– Uterine endometrial biopsy (obtaining a sample of the endometrium- must be
corkscrew)
– Hysteroscopy (introduction of hysteroscope through the cervix to visualize internal
reproductive structures)
– Laparoscopy (introduction of laparoscope through a small incision made on the
abdomen to visualize internal reproductive structures)
– Infertility evaluation:
Infertility Management
Increasing sperm count
o Advise to abstain from coitus for 7-10 days to allow maturation of sperm cells
o Lifestyle changes to reduce scrotal heat
Reducing the presence of infection through antibiotics
Managing erectile problems (most common is through the use of prescribed medication
such as Sildenafil (Viagra)
Hormone therapy research for the actions!!!!
o Clomiphene citrate (Clomid)
o Menotropins
o Low-dose estrogen

3. o Progesterone vaginal suppositories
Surgery
o Myomectomy
o Canalization (to eliminate obstruction Fallopian tube)
• Assisted Reproductive Techniques
o Artificial insemination – instillation of sperm into the female reproductive tract to aid
conception
- technique of micromanipulation that thins the zona
pellucida and inject sperm into the ovum in an effort to
enhance fertilization
o In vitro fertilization (IVF)– removing 1 or more mature oocytes from a woman’s ovary by
laparoscopy and then fertilizing them by exposing them to sperm under laboratory
conditions outside the woman’s body (placed on a dish together with the sperm)
o Embryo Transfer (ET)– ova transfer; insertion of laboratory grown fertilized ovum into
the wopman’s uterus approx. 40 hours after fertilization where 1 or more of them will
implant and grow
o Gamete intrafallopian transfer (GIFT) –ova and sperm are instilled in the patent fallopian
tube within a matter of hours without waiting for the fertilization t o occur in the laboratory
o Zygote intrafallopian transfer (ZIFT) – retrieval of oocytes, culture and insemination of
oocytes in the laboratory; fertilized eggs are transferred in the patent fallopian tube
within 24 hours
o Surrogate embryo transfer –oocyte from a donor is fertilized by the recipient woman’s
male partner’s sperm and placed in the recipient’s uterus by ET or GIFT
• Childbirth Alternatives
o Surrogate mothers
o Adoption
o Child-free living