Care of Subfertility Couple

• Infertility


  The inability to conceive a child or sustain a pregnancy to birth
• Subfertility

  Term that more often used today
• Types of subfertility


  • Primary subfertility
  • Secondary subfertility
  • Sterility
• Primary subfertility


  There have been no previous conceptions
• Secondary subfertility


  Has been a previous viable pregnancy but couple unable to conceive at present
• Sterility


  Inability to conceive because of a known condition, such as the absence of a uterus
• Male subfertility factors


  • Disturbance in spermatogenesis
  • Obstruction in the seminiferous tubules, ducts, or vessels preventing movement of spermatozoa
  • Quality or quantitative changes in the seminal fluid preventing sperm motility
  • Development of autoimmunity that immobilizes
  • Problems in ejaculation or deposition
• Inadequate sperm count


  Sperm count below 20M/mL of semen and less than 50M per ejaculation, with less than 50% motile and 30% in good shape
• Cryptorchidism


  • Lowered sperm production if surgical repair problem was not completed until puberty
• Varicocele


  • Varicosity of the spermatic vein
• Causes of obstruction or impaired sperm motility


  • Mumps orchitis
  • Epididymitis
  • Tubal infection (such as gonorrhea or ascending urethral infection)
  • Hypospadias
• Ejaculation problems


  • Erectile dysfunction
  • Premature ejaculation
• Erectile dysfunction


  Impotence or inability to achieve an erection resulted from psychological problems, CVA or Parkinson's disease
• Premature ejaculation


  Ejaculation before penetration, interfere with proper deposition of sperm
• Anovulation


  Absence of ovulation, occur from genetic abnormality such as Turner's syndrome which there no ovaries to produce ova
• Factors contributing to female subfertility


  • Hormonal imbalance
  • Ovarian tumors
  • Chronic or excessive exposures to X-rays
  • Poor diet
  • Stress
• Polycystic syndrome


  Ovaries produce excess testosterone, lowering FSH and LH levels
• Metabolic syndrome


  • Waist circumference of 35 or above, FBS >150mg/dL (8.3 mmoL), BP >135/85 mm Hg, High density lipoprotein cholesterol <50mg/dL
• Causes of tubal transport problems


  • Chronic salpingitis
  • Ruptured appendix
  • Abdominal surgery
  • Tubal ligation
• Pelvic inflammatory disease


  Infection of pelvic organs; uterus, fallopian tubes, ovaries and their supporting structures, caused by chlamydia or gonorrhea, affecting 25 per 100 women with 12% left subfertile
• Endometriosis


  Implantation of uterine endometrium, or nodules that have spread from the interior of the uterus to location outside the uterus, common sites include Douglas's cul-de-sac, ovaries, uterine ligaments, outer surface of uterus and bowel
• Fertility testing


  • Semen analysis (male)
  • Ovulation monitoring
  • Tubal patency assessment (female)
• Additional tests for men


  • Urinalysis, CBC, BT including Rh factor, test for syphilis, HIV, ESR and thyroid function, cholesterol and gonadotropin and testosterone levels
• Semen analysis


  After 2 to 4 days of sexual abstinence, the man ejaculates by masturbation into a clean, dry specimen jar, the number of sperm in the specimen are counted and examined under microscope within 1 hour
• Average ejaculation


  2.5 to 5 mL of semen and contains a minimum of 20 million spermatozoa per milliliter of fluid
• Ensuring an accurate semen analysis


  • Use a clean, dry plastic or glass container with a secure lid to collect the sample
  • Collect the specimen as close as possible to your usual schedule of sexual activity
  • Avoid using any lubricants when you collect the specimen
  • After you have collected the specimen in the container, close it securely and write down the time you collected it
  • Keep the specimen at body temperature while transporting it
  • Take the specimen to the laboratory or health care provider's office immediately so it can be analyzed within 1 hour of collection
• Sperm penetration assay and antisperm antibody testing


  Scheduled to determine whether a man's sperm, once they reach an ovum, can penetrate it effectively
• Intracytoplasmic sperm injection


  Poorly motile sperm or those with poor penetration can be injected directly into a woman's ovum under laboratory conditions
• Basal body temperature


  Record for 4 months, takes temp every morning before getting out of bed and engaging in any activities, increase in BBT marks the time of ovulation
• Ovulation determination by test strip


  Dips a test strip into a midmorning urine specimen and then compares it with the kit instructions for a color change
• Fertell


  Contains materials to test FSH on the third day of a woman's menstrual cycle, an abnormally high level is an indicator that her ovaries are not responding well to ovulation
• Sonohysterography


  Ultrasound technique designed for inspecting the uterus, the uterus is filled with sterile saline, introduced through a narrow catheter inserted into the uterine cervix
• Hysterosalpingography


  Radiologic examination of the fallopian tubes using a radiopaque medium
• Advanced surgical procedures


  • Uterine endometrial biopsy
  • Hysteroscopy
  • Laparoscopy
• Subfertility management


  • Increasing sperm count and motility
  • Reducing the presence of infection
  • Hormone therapy
  • Surgery
• Assisted reproductive techniques


  • Therapeutic insemination
  • In vitro fertilization
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Surrogate embryo transfer
• Therapeutic insemination


  Instillation of sperm into female reproductive tract to aid conception, preparation includes recording basal body temperature and assessing cervical mucus
• In vitro fertilization


  One or more mature oocytes are removed from a woman's ovary by laparoscopy and fertilized by exposure to sperm under laboratory conditions outside a woman's body, fertilized ova are then inserted into a woman's uterus
• Ovulation-stimulating agents used before in vitro fertilization


  • GnRH
  • Clomiphene citrate (Clomid)
  • Human menopausal gonadotropin (Pergonal)
• In vitro fertilization technique


  1. A needle is introduced intravaginally, guided by ultrasound, and the oocyte is aspirated from its follicle

  2. The oocytes are incubated for at least 8 hours to ensure viability

  3. The sperm cells and oocytes are mixed and allowed to incubate in a growth medium

  4. After fertilization of the chosen oocytes occurs, the zygotes formed almost immediately begin to divide and grow

  5. By 40 hours after fertilization, they will have undergone their first cell division, only one or two fertilized eggs are chosen and transferred back to the uterine cavity through the cervix by means of a thin catheter