Causes of Causes of Infertility in Men Infertility in Men

and Womenand WomenBy: Tammy, Merissa, and By: Tammy, Merissa, and

Heather Heather

For Nursing 519 Unit 6For Nursing 519 Unit 6

Infertility…an overviewInfertility…an overview

Infertility is defined as the Infertility is defined as the inability to conceive after 1 inability to conceive after 1 year of unprotected sex.year of unprotected sex.

Infertility affects Infertility affects approximately 15% of approximately 15% of couples (McCance couples (McCance &Huether, 2006). &Huether, 2006).

Infertility in MenInfertility in Men

Male factors influencing infertility Male factors influencing infertility include decreased production and include decreased production and quality of sperm as well as impaired quality of sperm as well as impaired delivery of sperm (McCance & Huether, delivery of sperm (McCance & Huether, 2006).2006).

Decreased production and quality of Decreased production and quality of sperm include the following factors: sperm include the following factors: Impaired shape and movement of Impaired shape and movement of sperm, low sperm counts, varicocele, or sperm, low sperm counts, varicocele, or infection (Mayoclinic.com, 2007). infection (Mayoclinic.com, 2007).

In men, hyperthyroidism can decrease In men, hyperthyroidism can decrease production and motility of sperm, in production and motility of sperm, in comparison to women, where comparison to women, where hypothyroidism can decrease fertility hypothyroidism can decrease fertility (McCance & Huether, 2006).(McCance & Huether, 2006).

Impaired delivery of sperm may Impaired delivery of sperm may include the following factors: Blockage include the following factors: Blockage of the epididymis or ejaculatory ducts, of the epididymis or ejaculatory ducts, hydrospadias, or anti-sperm hydrospadias, or anti-sperm antibodies (Mayoclinic.com, 2007).antibodies (Mayoclinic.com, 2007).

Health and lifestyle factors such as Health and lifestyle factors such as stress, drug or alcohol abuse, and a stress, drug or alcohol abuse, and a history of radiation to the testicles history of radiation to the testicles impact male impact male fertility (Mayoclinic.com, 2007).fertility (Mayoclinic.com, 2007).

In addition, a history of STDs, In addition, a history of STDs, smoking, and chemical exposure are smoking, and chemical exposure are other factors that may impact male other factors that may impact male fertility (McCance & Huether, 2006). fertility (McCance & Huether, 2006).

Infertility in WomenInfertility in Women

Common Causes of Infertility in Common Causes of Infertility in WomenWomen

Retrieved from Fertility.comRetrieved from Fertility.com

Retrieved from Fertility.com

Polycystic Ovarian Disease Polycystic Ovarian Disease (PCOD)(PCOD)

In POD, ovaries become In POD, ovaries become enlarged. They have a smoother enlarged. They have a smoother and thicker layer than and thicker layer than nondiseased ovaries. They are nondiseased ovaries. They are covered with small cysts, which covered with small cysts, which may cause amenorrhea or may cause amenorrhea or infrequent menstrual cycles infrequent menstrual cycles (Cooper, 2007). (Cooper, 2007).

POD can be classified into three POD can be classified into three categories:categories:

MildMild – women with mild POD may – women with mild POD may take longer to conceive, but can take longer to conceive, but can conceive nevertheless. They have conceive nevertheless. They have normal ovulation. There is an normal ovulation. There is an increased incidence of increased incidence of spontaneous miscarriage spontaneous miscarriage associated with Mild POD.associated with Mild POD.

ModerateModerate – These women do not – These women do not ovulate or have infrequent cycles. ovulate or have infrequent cycles. They will have amenorrhea. They will have amenorrhea.

SevereSevere – No menses present. – No menses present. Women are infertile. These Women are infertile. These women are usually obese and women are usually obese and display hirsutism (facial hair) display hirsutism (facial hair) (Cooper, 2007).(Cooper, 2007).

An over production of luteinizing An over production of luteinizing hormone by the pituitary gland causes hormone by the pituitary gland causes abnormally high levels of androgens in abnormally high levels of androgens in the body, specifically testosterone. the body, specifically testosterone.

According to Wikipedia.com, “aAccording to Wikipedia.com, “a majority of patients with PCOS have majority of patients with PCOS have insulin resistance and/or are obese. insulin resistance and/or are obese. Their elevated insulin levels contribute Their elevated insulin levels contribute to or cause the abnormalities seen in to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis the hypothalamic-pituitary-ovarian axis that lead to PCOS” (2009). that lead to PCOS” (2009).

EndometriosisEndometriosis

Endometriosis occurs when the Endometriosis occurs when the endometrium proliferates, spreading into endometrium proliferates, spreading into the pelvis. Infertility occurs when it the pelvis. Infertility occurs when it implants onto the pelvic floor causing implants onto the pelvic floor causing obstruction with adhesions. It may cause obstruction with adhesions. It may cause damage to the fallopian tubes and ovaries. damage to the fallopian tubes and ovaries. Women with this disorder may have very Women with this disorder may have very painful, heavy and long menses. painful, heavy and long menses. Interestingly, the amount of symptoms Interestingly, the amount of symptoms present is not reflective of the degree of present is not reflective of the degree of disease present (Cooper, 2007).disease present (Cooper, 2007).

The exact cause of endometriosis is The exact cause of endometriosis is unknown. It is hypothesized that unknown. It is hypothesized that several etiologies could lead to the several etiologies could lead to the disease including increased estrogen disease including increased estrogen levels, retrograde menstruation, levels, retrograde menstruation, lymphatic or vascular distribution, lymphatic or vascular distribution, immune system dysfunctions and immune system dysfunctions and genetic factors (endometriosis.org, genetic factors (endometriosis.org, 2007).2007).

Pelvic Inflammatory Pelvic Inflammatory Disease (PID)Disease (PID)

PID is usually caused by sexually PID is usually caused by sexually transmitted diseases like Chlamydia transmitted diseases like Chlamydia and Gonorrhea. PID is the main and Gonorrhea. PID is the main cause of tubal infertility because cause of tubal infertility because mucus is altered in the tubes and mucus is altered in the tubes and adhesions and obstructions are adhesions and obstructions are formed (Cooper, 2007).formed (Cooper, 2007).

A question to ponder…A question to ponder…

What role can NPs play in What role can NPs play in assisting couples experiencing assisting couples experiencing infertility?infertility?

ReferencesReferences Cooper, M. (2007). Female infertility: Cooper, M. (2007). Female infertility:

pathophysiology. pathophysiology. Practice Nursing, (18)Practice Nursing, (18)12. 12. 611-614.611-614.

Denson, V. (2006). Diagnosis and Denson, V. (2006). Diagnosis and management of infertility. management of infertility. American College American College of Nurse Practitioners, (2)of Nurse Practitioners, (2)6. 380-3866. 380-386

Endometriosis.com (2007). What causes Endometriosis.com (2007). What causes endometriosis? Retrieved February 10, 2009, endometriosis? Retrieved February 10, 2009, from from http://www.endometriosis.org/causes.htmlhttp://www.endometriosis.org/causes.html

Fertility.com (2008). PCOD: Polycystic ovary Fertility.com (2008). PCOD: Polycystic ovary disease. Retrieved February 10, 2009, from disease. Retrieved February 10, 2009, from http://www.fertility.com/international/concerhttp://www.fertility.com/international/concern/Infertility_in_Females/Ovulatory/Polycysticn/Infertility_in_Females/Ovulatory/Polycystic_Ovary_Disease.jsp_Ovary_Disease.jsp

References continuedReferences continued Mayoclinic.com (2007). Infertility. Mayoclinic.com (2007). Infertility.

Retrieved February 9, 2009 from Retrieved February 9, 2009 from http://www.mayoclinic.com/health/infertilityhttp://www.mayoclinic.com/health/infertility/DS00310/DSECTION=causes/DS00310/DSECTION=causes

McCance, K., & Huether, S. (2006). McCance, K., & Huether, S. (2006). Pathophysiology: The biologic basis for Pathophysiology: The biologic basis for disease in adults and children. (5th ed.). St. disease in adults and children. (5th ed.). St. Louis, MI: Elsevier Mosby. Louis, MI: Elsevier Mosby.

Wikipedia. (2009, February). Polycystic Wikipedia. (2009, February). Polycystic ovary syndrome. Retrieved February 10, ovary syndrome. Retrieved February 10, 2009, from 2009, from http://en.wikipedia.org/wiki/Polycystic_ovarhttp://en.wikipedia.org/wiki/Polycystic_ovary_syndrome#Pathogenesisy_syndrome#Pathogenesis