IP International Journal of Medical Paediatrics and Oncology 2021;7(3):174–177

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IP International Journal of Medical Paediatrics and

Oncology

Journal homepage: https://www.ijmpo.com/

Case Report
Infertility: A case study

Almond Kamei1, *, Nasima Laskar1

1 Dept. of Obstetrics and Gynaecology Nursing, Army institute of Nursing, Guwahati, Assam, India

ARTICLE INFO ABSTRACT

Article history: Infertility is a disease of the male or female reproductive system defined by the failure to achieve a
Received 23-08-2021 pregnancy after 12 months or more of regular unprotected sexual intercourse. It affects millions of people
Accepted 28-09-2021 of reproductive age worldwide. Fertility care encompasses the prevention, diagnosis and treatment of
Available online 14-10-2021 infertility. It is vital part of the nurse to offer psychological support to the couple and provide nursing
Management based on the priority.
Keywords: This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons
Reproductive age Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon
Nursing approach the work non-commercially, as long as appropriate credit is given and the new creations are licensed under
the identical terms.
For reprints contact: [email protected]

1. Introduction with the male reproductive system. 2 In the female

reproductive system, infertility may be caused by a
Around 48 million couples and 186 million individuals live
range of abnormalities of the ovaries, uterus, fallopian
with infertility globally. 1 in 7 couples need specialist help
tubes, and the endocrine system, defective transport and
to conceive, including some couples who have conceived
defective implantation like hormonal imbalance, congenital
before. Prevalence of infertility has not changed although
anomalies, fibroids and infection. 3 In the male reproductive
more couples are seeking help more than previously.
system, infertility may be caused by obstruction of the
Infertility can be primary or secondary. An estimated
reproductive tract causing dysfunctionalities in the ejection
1 in 10 women between the ages of 15 and 44 have
of semen. hormonal disorders leading to abnormalities in
trouble conceiving. 1
hormones produced by the pituitary gland, hypothalamus
Although both women and men can experience
and testicles. Testicular failure to produce sperm. Abnormal
infertility, women in a relationship with a man are often
sperm function and quality. 2
perceived to suffer from infertility, regardless of whether
they are infertile or not. Infertility has significant negative
social impacts on the lives of infertile couples and
particularly women, who frequently experience violence, While assisted reproduction technologies (ART) have
divorce, social stigma, emotional stress, depression, anxiety been available for more than three decades, with more than
and low self-esteem. 5 million children born worldwide from ART interventions
such as in vitro fertilization.
1.1. Etiology
1 in 3 infertile women have a problem with the female
reproductive system.1 in 3 infertile men have a problem (IVF), these technologies are still largely unavailable,
* Corresponding author. inaccessible and unaffordable particularly in low and
E-mail address: [email protected] (A. Kamei). middle-income countries (LMIC). 4

https://doi.org/10.18231/j.ijmpo.2021.035
2581-4699/© 2021 Innovative Publication, All rights reserved. 174
 Kamei and Laskar / IP International Journal of Medical Paediatrics and Oncology 2021;7(3):174–177 175

1.2. Diagnosis can make sperm healthier and can improve the odds of
conception.
1.2.1. For female 3. Fertility treatment options for all genders
1. Pelvic exam: including a Pap smear to check for 4. Intrauterine insemination (IUI): A healthcare provider
structural problems or signs of disease. uses a long, thin tube to place sperm directly into the
2. Blood test: A blood test can check hormone levels, uterus.
including thyroid hormones 5. In vitro fertilization (IVF): IVF is a type of assisted
3. Transvaginal ultrasound: Doctor inserts reproductive technology (ART). It involves harvesting
an ultrasound wand into the vagina to look for the eggs at the end of the stimulation and placing sperm
problems with the reproductive system. and eggs together in a lab dish. The sperm fertilize the
4. Hysteroscopy: inserting a thin, lighted tube eggs. A provider transfers one of the fertilized eggs
(hysteroscope into the vagina to examine the uterus (embryo) into the uterus.
5. Saline sonohysterogram (SIS): filling the uterus 6. Intracytoplasmic sperm injection (ICSI): This
with saline (sterilized salt water) and conducts a procedure is similar to IVF. An embryologist (highly
transvaginal ultrasound. A full uterus makes it easier specialized lab technician) directly injects a single
to see inside the uterus. sperm into each of the harvested eggs and then a
6. Hysterosalphingogram (HSG): X-rays capture an provider transfers an embryo into the uterus.
injectable dye as it travels through the fallopian tubes. 7. Third-party ART: Couples may use donor eggs,
This test looks for blockages. donor sperm or donor embryos. Some couples need a
7. Laparoscopy: health provider inserts a laparoscope gestational carrier or surrogate. This person agrees to
(thin tube with a camera) into a small abdominal carry and give birth to your baby. 4
incision. Female pelvic laparoscopy helps identify
problems like endometriosis, uterine fibroids and scar
1.4. Prevention
tissue.
1.4.1. Men and women can take these steps to protect their
1.2.2. For males fertility, especially while trying to conceive
These tests can help diagnose or rule out a male fertility 1. Eat a well-balanced diet and maintain a healthy
problem: weight.
1. Semen analysis: This test checks for problems with 2. Don’t smoke, misuse drugs or drink excessively.
sperm, such as low sperm count and poor mobility. 3. Get treated for STDs.
Some men need a needle biopsy to remove sperm from 4. Limit exposure to toxins.
the testicles and test it. For most men, this is the only 5. Stay physically active, but don’t overdo exercise.
test that will be needed in the workup of infertility.
2. Blood test: A blood test can check testosterone, 1.5. Prognosis
thyroid and other hormone levels. Genetic blood tests Approximately 9 out of 10 couples get pregnant after
look for chromosomal abnormalities. undergoing fertility treatments. Success rates vary
3. Scrotal ultrasound: An ultrasound of the scrotum depending on the cause of infertility, the couple’s ages and
identifies varicoceles or other testicular problems. 2,5 other factors. In general:

1.3. Treatment 1. Each IUI attempt has a 20% success rate

2. An estimated 1 in 2 women under the age of 35
1.3.1. Treatments for female infertility include
conceive with ART. That number drops to 1 in 30
1. Medications: Fertility drugs change hormone levels to
women (3%) for women in their early to mid-40s. 7,8
stimulate ovulation.
2. Surgery: Surgery can open blocked fallopian tubes
2. Nursing management: A case study
and remove uterine fibroids and polyps. Surgical
treatment of endometriosis doubles a woman’s chances A Case study of a female with infertility is discussed with
of pregnancy. 6 consent from her. Mrs X, 32 years old was admitted in ante
natal ward at Guwahati Medical College Hospital on 23-
1.3.2. Treatments for male infertility include 04-2020 with the chief complaints of not able to conceive
1. Medications: Medications can raise testosterone or pregnancy for last two years, irregular menstruation for
other hormone levels. There are also drugs for erectile three month, pain in lower abdomen for two weeks,
dysfunction. weakness for two weeks. She had a history of miscarriage
2. Surgery: Some men need surgery to open blockages in two years back. She has no past medical history except
the tubes that store and carry sperm. Varicocele surgery some cold and fever. In family history, her elder sister
176 Kamei and Laskar / IP International Journal of Medical Paediatrics and Oncology 2021;7(3):174–177

also developed same complaint and she was found as 2.3.1. Expected outcome
first degree infertility on arrival, vital signs are stable. The woman will be able to understand the treatment
Hysterosalphingogram (HSG) was done and report shows procedure.
that there is some blockage in the right fallopian tube. Chest
X ray was also done and report shows normal findings. 2.3.2. Nursing interventions:
1. Encouraged the woman to ask her doubts
2.1. Nursing diagnosis 2. Allowed her to express her feelings
3. Discussed with the woman about the treatment
Acute pain related to infertility treatment as evidenced by
prognosis.
patient’s facial expression and by her own verbalisation.
4. Encouraged woman to support herself physically and
psychologically.
2.1.1. Expected outcome
The woman will be able to express decreased pain.
2.3.3. Evaluation
Woman understood the treatment process and coorperated
2.1.2. Nursing intervention
well.
1. Assess the severity and duration of the pain.
2. Observed precipitating factors recurrence and
3. Conclusion
progressive characteristics. The woman’s pain level
measured using Wong Baker’s faces scale as 6. Generally worldwide it is estimated that 1 in 8 couples have
3. Provided basic comfort measures (e.g. repositioning) problems in conceiving. Nearly 80% of couples achieve
and leasure activities (e.g. watching TV). conception, if they so desire within 1 year of having regular
4. Advised her to talk to families, use distraction therapy intercourse with adequate frequency another 10% remain
as well as other methods of pain relief. infertile by the end of third year. Infertility primariliy refers
5. Administered analgesics (Tablet Diclofenac Sodium to the biological ability of the person to contribute to
50 mg BD as per Doctors prescription). conception. In both men and woman the fertility process is
complex. Infertility problems are due to female as well as
2.1.3. Evaluation male infertility or combination of both. Although testing of
The woman expressed level of pain as 2 in Wong baker’s testing in woman, it is equally important for the male partner
pain scale and she was comfortable and ventilating her to be tested at the same time.
feelings with her family members.
4. Acknowledgement
2.2. Nursing diagnosis
I am so thankful to the woman who was the part of the study
Anxiety related to the disease process as evidenced by for her kind cooperation I thank Mrs M. Jayalakshmi, Rtd.
frequent asking of questions. Lt. Col. Principal, Army Institute of Nursing, Guwahati,
Assam.
2.2.1. Expected outcome
The woman will express decreased anxiety 5. Source of Funding
None.
2.2.2. Nursing interventions:
1. Assessed the level of anxiety.
6. Conflicts of Interests
2. Assessed the degree of experience of pain and the
current stage of knowledge None
3. Provided information that is accurate and truthful.
4. Inform the family about supervision and treatment. References
5. Encouraged the family to acknowledge the problem
1. World Health Organization (WHO). International Classification of
and express feelings. Diseases, 11th Revision (ICD-11) Geneva: WHO 2018 (intro part).
2. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens
2.2.3. Evaluation GA. National, regional, and global trends in infertility prevalence
since 1990: a systematic analysis of 277 health surveys. PLoS Med.
The woman was happy and able to cope up with the e1001356;9(12). doi:10.1371/journal.pmed.1001356.
condition. 3. Available from: https://www.plannedparenthood.org/learn/pregnancy/
infertility.
2.3. Nursing diagnosis
Knowledge deficit related to treatment and prognosis as
evidenced by frequent asking of question of disease.
 Kamei and Laskar / IP International Journal of Medical Paediatrics and Oncology 2021;7(3):174–177 177

4. Centers for Disease Control and Prevention. . Accessed 8. Office on Women’s Health. Accessed12/16/2020.Infertility. Available
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from: https://www.cdc.gov/art/whatis.html.
5. Mascarenhas MN, Flaxman SR, Boerma T. National, regional,
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analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.
doi:10.1371/journal.pmed.1001356. Almond Kamei, Tutor
6. Eunice Kennedy Shriver National Institute of Child Health and Human
Development. . Accessed 12/16/2020.Fertility Treatments for Females Nasima Laskar, Tutor
. Available from: https://www.nichd.nih.gov/health/topics/infertility/
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are-my-options/insurance-coverage/infertility-coverage-state/);. Med Paediatr Oncol 2021;7(3):174-177.