INFERTILTY

PRESENTED BY:

ANWAR ALI MALIK

BSN, MPH-I
REPRODUCTIVE HEALTH
2015-2017
malik.anwarali@yahoo.com
#03073279315

OBJECTIVES:
At The End Of This Presentation, You Will Be Able To Understand:

1.

What Is Fertility And Infertility?

2.

What Is Primary And Secondary Infertility?

3.

What Is A Global Prevalence Of Infertility?

4.

What Are The Male And Female Causes Of

Infertility?

5.

What Is Management Of Infertility?

6.

What Are The Recommendations And Prevention

Of Infertility?

FERTILITY:
Fertility

is defined as the ability of a man and woman

to reproduce A children.

INFERITILTY:
while

infertility denotes lack of fertility, or an

involuntary reduction in the ability to produce

children.

INFERTILITY
Clinical definitions:
Infertility is a disease of the reproductive
system defined by the failure to achieve a
clinical pregnancy after 12 months.
(WHO-ICMART glossary1).

Primary

infertility;
couple have failed to conceive a baby before.
Secondary

infertility;
woman has previously been pregnant and now
unable to conceive a baby.

Epidemiological definition of infertility

(for

monitoring and surveillance) Women of

reproductive age (1549 years) at risk of
becoming pregnant who report trying
unsuccessfully for a pregnancy for two years or
more.
(Reproductive

Health Indicators).

Global prevalence of infertility:

Guidelines

for their generation,

interpretation and analysis for
global monitoring, a formula has
been determined for nations to
monitor infertility prevalence in
women.

Prevalence

data

for

men

is

unknown..
WHO Reproductive Health Indicators,

WHO evaluation of Demographic and

Health Surveys (DHS) data (2004),
estimated that more than 186 million
ever-married women of reproductive age
in developing countries were maintaining
a "child wish, translating into one in
every four couples.

Global

infertility prevalence rates are difficult

to determine, due to the presence of both male
and female factors which complicate any
estimate.

 The

difficulty to address infertility prevalence is

coupled with the lack of consistent use of
definitions and lack of common tools to diagnose,
manage or report infertile individuals and
couples, worldwide.

 The

burden remains high. A WHO study,

published at the end of 2012, has shown that
the overall burden of infertility in women
from 190 countries has remained similar in
estimated levels and trends from 1990 to
2010.

Infertility as a disability
Disability:

Infertility generates disability (an

impairment of function).

An

estimated 34 million women, predominantly

from developing countries, have infertility which
resulted from maternal sepsis and unsafe.

Infertility

in women was ranked the 5th highest

serious global disability (among populations
under the age of 60).

 Even

though there is a high fertility rate

in Pakistan, but in spite of,
approximately 21.9% percent of couples
in the country suffer from infertility.

Infertility

is considered primarily a
womens problem, and the role that men
play in conception is often unnoticed.

 Infertility

thus creates psychological,

emotional, and social problems for
women because they are blamed for
not being able to produce children.

whereas

men

are often ready to

marry again without seeking medical
attention for the causes of possible
male infertility.

 Infertility

is a highly sensitive problem for

couples.
They

may be helped to conceive through

counselling/education, diagnosis, and
correct guidance for treatment.

A proper

evaluation can avert/to turn aside

or away much unhappiness, family crises
and, in many cases, a marital breakup.

CAUSES ANF FACTORS OF INFERTILITY IN

MALE/FEMALE
1.

UNEXPLAINED:

( 28 percent ) : no identifiable cause

2.

MALE FACTORS :

(23 percent )

3.

FEMALE FACTORS : ( 44 percent)

4.

COITAL FACTORS : ( 05 percent) interaction of sperm and

cervical mucus.

. Antibodies

to sperm

MALE FACTORS: (23 percent)

Low

sperm quality ( sperm count, motility, morphology

Hormone

abnormalities:

Previous vasectomy:

Genetic/

chromosomes abnormalities.
(absence of one or both testes or
from the scrotum during foetal

Cryptorchidism:

undescended
development).
Testicular
Varicocele

cancer
( dilation of veins in the scrotum) lead to

infertility.
Defect

in specific hormones and hormone receptors.

Exposure

to tobacco (smoking), infection, specific

medications, environmental hazards, and toxins.

FEMALE FACTORS: 44 (percent)

Decrease or absent ovulation:

Pelvic adhesions: Adhesions are bands of scar tissue that can cause internal
organs to be stuck together.

Hyperprolactinemia: High prolactin hormones level in women can change or

stop ovulation.

Previous tubal sterilization: Tubal sterilization is a type of surgery that

keeps you from getting pregnant. It closes off the fallopian tubes.

- Endometriosis: It is the development of uterine-lining tissue outside the

uterus.

- Uterine fibroids: (Uterine fibroids (benign) growths that develop in the

muscular wall of the uterus).

Uterine septum: (A uterine septum is an upside-down, triangular shaped piece

of tissue which divides all or part of the uterine cavity in two).

Blockage of fallopian tubes:

Cervical infection and narrowing of the cervix due to cancer or previous

surgery.

RISK FACTORS IN FEMALE PARTNERS:

Oligomenorrhoea

( greater than > 6 weeks between

each menstrual cycle).

Amenorrhea

( absence of menstruation period, which

leads to decreased or absent ovulation.

Overweight

or underweight: BMI should be greater

than 18.5 and less than 25.

Too much caffeine intake: approximately more than

10 cups of tea or 2 cups of coffee per day.

Too

much exercise:

Eating

disorders:

RISK FACTORS IN BOTH MALE AND FEMALE

PARTNERS:
Older

age

Smoking
Heavy

alcohol use

Stress
Infection
Exposure

of reproductive organs

to environmental hazards and

toxins including radiation, pesticides, lead,
and mercury.

Management
1.
2.
3.
4.
5.

Counselling and
waiting.
Treatment of the cause.
Ovulation induction.
Artificial insemination
(IUI/ICI)
IVF/ICSI

 This

task can be performed by health

care providers in the community who
can assist in diagnosis, education, and
counselling and provide guidance.

They

should also refer cases of sexual

dysfunction, which may be agerelated, and are influenced by health
and psychosocial factors.

HEALTH CARE PROVIDERS SHOULD BE

ABLE TO:
Give

the couple moral support and encouragement.

Counsel

couples about infertility.

Educate

couples about infertility.

Take
Do

a proper history.

a thorough physical examination.

Refer

couples to infertility centers or specialists.

INITIAL RECOMMEDATIONS/PREVENTION
OF INFERTILITY:
Have

regular intercourse during the fertile

period.

Plan

to start having children before 35 years old,

if possible.

Improve

body weight.

Minimize
Stop

stress.

smoking

 Decrease

or stop alcohol use.

Decrease

caffeine intake.

Eliminate

exposure to environmental hazards and

toxins.
Avoid

exposure to STIs/STDS by using condoms

and limiting the number of sexual partners to avoid
diseases occurrence ( such as chlamydia,
gonorrhea, syphilis and trichomoniasis.).

THANX