Introduction-: A womans age is the main factor affecting a couples chances of

achieving a successful pregnancy. A womans fertility peaks between the ages of 20 and
30 years. From 30 to 35 years of age, female fertility starts to slowly decline. Once a
woman turns 35, her fertility begins to drop more rapidly. Over the age of 40, women
have significantly lower chances for conception each month.
Incidence
The 12-month prevalence rate ranged from 3.5% to 16.7% in more developed
nations and from 6.9% to 9.3% in less-developed nations, with an estimated overall
median prevalence of 9%.
Based on these estimates and on the current world population, 72.4 million women
are currently infertile; of these, 40.5 million are currently seeking infertility medical
care. 10%of general population suffers from of infertility. 1.2 number billion, the
number of Indians suffering from infertility.
In India 13-25% infertility ratio is present.
Fertility level:
Total fertility rate has declined to 2.7 children /women in 2005-2006.
TFR Is Varies With The Education-: TFR of women who have completed 12 or
more years of education is almost half of that of women have had no education at
all.

Definition: The World Health Organization defines infertility as follows:

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
(and there is no other reason, such as breastfeeding or postpartum amenorrhoea).
Infertility is defines as a failure to conceive within one or more year of regular
unprotected cotius
Types of infertility
Primary infertility
Secondary infertility
Primary infertility-:Couples has never produced a pregnancy.
Secondary infertility-: Women has previously been pregnant, regardless of the
outcome, and now is unable to conceive.

Factors responsible for infertility

Healthy spermatozoa
Spermatozoa should undergo certain changes
Motile spermatozoa
Ovulation
Fimbriated activity of tube
Spermatozoa should fertilize the oocyte at the end of ampulla
Uterine activity
Endometrial changes.

Risk factors in male

Thermal factors-: the scrotal temperature is high in condition such as
varicocele and big hydrocele .or increase catecholamine
Tight undergarment or working in hot atmosphere
Depressive spermatogenesis
Infection: mumps orchities
General factors-:Alcohol inhibits spermgetonesis process by damage the
leyding cell synthesis of testosterone or suppress the gonadotropins level
Malnutrition or heavy smoking
Endocrine :testicular failure due to gonadotropines(kallmanns syndromes)
Genetic: klinefelter syndrome
Exposure to toxins and environmental hazards, lead, radiation, radioactive
substances, mercury, and heavy metals may affect fertility

Risk factors of female

Age. With increasing age, the quality and quantity of a woman's eggs begin to
decline. In the mid-30s, the Smoking. Besides damaging your cervix and
fallopian tubes, smoking increases your risk of miscarriage and ectopic
pregnancy. It's also thought to age your ovaries and deplete your eggs
prematurely, reducing your ability to get pregnant. Stop smoking before
beginning fertility treatment.
Weight. If you're overweight or significantly underweight, it may hinder normal
ovulation. Getting to a healthy body mass index (BMI) has been shown to
increase the frequency of ovulation and likelihood of pregnancy.
Sexual history. Sexually transmitted infections such as chlamydia and
gonorrhea can cause fallopian tube damage. Having unprotected intercourse with
multiple partners increases your chances of contracting a sexually transmitted
disease (STD) that may cause fertility problems later.
Alcohol. Heavy drinking is associated with an increased risk of ovulation
disorders and endometriosis.
Causes of male infertility
1.Defective spermatogenesis
2.Obestuction of efferent duct : Any obstructions in the vas deferens or epididymis
(the tubes that transport fertile sperm). Infection, such as chlamydia or gonorrhoea,
injury, or birth defects can cause a blockages. Varicoceles, enlarged veins in the
scrotum, may also affect sperm production.
3. Erroe in the seminal fluid
4. Congenital abnormality undescended testes
5. Sperm abnormality
Azoospermia. No sperm are produced, or the sperm aren't appearing in the semen.
Oligospermia. Few sperm are produced.
Problems with sperm motility. If sperm aren't moving normally, they are less
likely to be capable of fertilizing an egg.
Problems with sperm morphology. Problems with the form and structure -- or
morphology -- of the sperm may cause infertility.
Cause of female infertility
1. Anovulation or oligo-ovulation: Any condition (usually hormonal) that prevents
the release of a mature egg from an ovary.

2. Eggs that become damaged or develop chromosomal abnormalities cannot

sustain a pregnancy. This problem is usually age-related, as egg quality declines
significantly in the late 30s and early 40s.
3. Luteal phase defect
4. Polycystic ovarian syndrome: is caused by a hormone imbalance that disrupts
ovulation. The ovaries develop many small cysts instead of ripening and
maturing one egg each cycle.
5. Premature ovarian syndrome
6. Eating disorder
7. Damage the uterus or
8. fallopian tube: Blocked or damaged fallopian tubes prevent eggs from getting to
the uterus and sperm from getting to the egg. Leading causes include pelvic
inflammatory disease, sexually transmitted diseases such as chlamydia, and
previous sterilisation surgery.
9. P.I.D(Pelvic Inflammatory Disease)
10.A Previous Ectopic Pregnancy
11.Endometriosis Or Fibroids: This condition, in which endometrial tissue (the
uterine lining that sheds with each monthly period) grows outside the uterus.
Endometriosis is an important factor in infertility, as it can cause tubal blockages
and ovulation problems.
12.Abnormal Cervical Mucus
13.Scar Tissue
Diagnostic evaluation
semen analysis
confirmation of ovulation
tubal patency

Diagnostic test for male infertility

Semen analysis-: In this semen sample by masturbating and ejaculating into a
special container at the doctor's office or by using a special condom to collect semen
during intercourse. and semen is sent to a laboratory to measure the number of
sperm present and look for any abnormalities in the shape (morphology) and
movement (motility) of the sperm. The lab will also check semen for signs of
problems such as infections.

According to W.H.O semen analysis result

Volume=2.0 ml
Ph=7.2-7.8
Sperm concentration=20 million
Total sperm count=>40 million
Motility 50 per cent
Morphology
Viability=75%
Leucocytes=less than 1 million /mal
Sperm agglutination <2

2. Serum FSH, LH, TESTERRONE, Prolactine and TSH-:may have leading cell
dysfunction
3.Testicular biopsy4.Testicular ultrasound5.Vasograme-:Is a radiographic study done to evaluate the ejaculatory duct
obstruction .
6.karyotype analysis micro detection of long arm of Y chromosome.
7. Immunological test-: In that have 2 antibodies. one is sperm agglutinating and
sperm immersing.
8.pus cell examination

Diagnostic test for female infertility

B.B.T (basal body temperature)-:Woman can check her body temperature
each morning. Basal body temperature rises a bit just after ovulation. By

checking her body temperature each morning, a woman can detect this rise,
showing her ovulation pattern over months.
Ultrasonography-:In the ultrasonography visualization of the internal
reproductive organ and detect the cause of the infertility.
Cervical mucus study-:cervical mucus is an excellent predictor of fertility. for
the cervical mucus study with the sterile hand, it insert in to the vagina and
take the sample of mucus then assess the characterstics of the mucus.
Hystero salpingography-: It is done for the visualization of the uterus and
fallopian tube.Use radio paque and water soluble dye injected through
cannula inside uterine cavity and take X-ray and detect the abnormality.
Pap smear-: The pap smear is a screening test for cervical cancer. in this cells
scraped from the opening of the cervix are examined under the microscope.
Laboratory test-: Check hormone levels and other lab test.

Management -: Infertility management includes the

Medical management
Surgical management
Nursing management

Medical management
Human menopausal gonadotropin or hMG:-This injected medication is for
women who dont ovulate on their own due to the failure of the pituitary
gland to stimulates ovulation . HMG contains both FSH and LH and directly
stimulates the ovaries to ovulate.
FSH:- FSH work by stimulating the ovaries to produce mature egg follicle.
Gonadotropin-releasing hormone(Gn-RH):-Along these medicine are used for
women who dont ovulate regularly in each month. it is directly act on

pituitary gland to change when the body ovulate .These medicine are usually
injected or given nasal spray
Metformin:-this medicine is used when insulin resistance is known or
suspected causes of infertility. usually women a diagnosis with Polycystic
ovarian syndrome.
Letrozole: It induced the ovulation
Bromocriptine: This medicine used for women with ovulation problem due to
high level of prolactine.

Surgical management
A.R.T(Assisted reproductive technology)-:It includes;
I.U.I=Intrauterine insemination
I.V.F=In vitro fertilization
G.I.F.T=Gamete intrafallopian transfer
Z.I.F.T=Zygote intrafallopian transfer

1.Fertility restoration: surgery

Tissue removal-: This surgery remove endometrial tissue with lasers which can
improves the achieving the pregnancy.
Tubal reversal surgery: After a women has had her tube tied for permanent
contraception (tube ligation) , surgery may be done to reconnected them and restore
fertility.
Tube surgeries: If fallopian tube are blocked or filled with fluid, With the help of
the laparoscopic surgery achieving the pregnancy.

2.Intrauterine insemination (IUI) -: Type of artificial insemination is a procedure

for treating infertility. Sperm that have been washed and concentrated are placed
directly in to the uterus around the time of ovary releases one or more eggs to be
fertilized. Older types of artificial insemination placed the sperm in the vagina.
While this was easier, it was not as successful as the current procedure.

3.IVF:In vitro fertilization

IVF is a form of assisted reproductive technology (ART). This means special
medical techniques are used to help a woman become pregnant. It is most often tried
when other, less expensive fertility techniques have failed.
in vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a
laboratory dish. In vitro means outside the body. Fertilization means the sperm has
attached to and entered the egg.

4.Gamete intrafallopines transfer: GIFT involves transfer the embryo is similar to

IVF, fertilization occur in laboratory .then very young embryo is transferred into
fallopian tube .
Gamete intrafallopian transfer: GIFT involves transferring eggs and sperm into the
women s fallopian tube so s fertilization occurs in womens body.
5.Z.I.F.T=Zygote intrafallopian transfer-:ZIFT is an infertility treatment it used
when a blockage in the fallopian tubes prevent the normal binding of sperm to the
egg.
Egg cells are removed from a women's ovaries, and in vitro fertilized. Resulting
Zygote is placed in to the fallopian tube by the use of laparoscopy.
Nursing management
Nursing diagnosis-:
1.knowledge deficit related to sign & symptoms of infertility.
2.low self esteem related to the infertility.
3.Grieving related to the poor prognosis of infertility treatment.
4.Anxiety related to the infertility.
5.self care activity deficiate related to infertility.

6.Social isolation related to infertility.

Role of nurses in Infertility management

Infertility affect the large number of couples worldwide, who consult infertility
centers for the treatment.
A typical infertility center comprises doctors, nurses, scientists and
psychologist/counselors. The nurse commonly referred as infertility nurse is the
main contact person for the couple at the center.
The role of the nurse in Assisted reproductive technologies has evolved as the need
of the couples and infertility programmes have changed.This multidimensional
nursing role encompasses skills as a manager, educator, counselor, researcher and
professional. The role of the nurse in the infertility management programs is
widespread.
Prognosis-:
The overall successful treatment for infertility is nearly 50%,but this varies by
cause, age of the female partner, history of previous fertility and duration of
infertility.
Of the various etiologies, infertility attributed to ovulatory dysfunction has the best
prognosis, with treatment success rates approaching overall 50%.
Infertility caused by tubal factor or severe endometriosis has the least likelihood for
success.
The Chance of pregnancy i influenced by the duration of the infertility and previous
child birth and the age of the female partner.

Summary-:Till now we discussed about the infertility how is occur, male in female
infertility, causes of infertility, what is diagnosis of the infertility, level of TFR(total
infertility rate) and how infertility is varies with the education, factors affecting the
infertility, and finally we taught about the how to manage the infertility, and role of
nurses for infertility.

Conclusion-:This teaching has shown that about the knowledge of infertility, how it
occur and what is the incidence of infertility in now a days, as well prognosis. so the
teach after this topic conclusion is that now infertility is correct and infertile women
can get the chance of the reproduction.
Prognosis of infertility is also good.