Chapter 26: Infertility

Infertility establishes foundational terminology by distinguishing between primary and secondary infertility before detailing the complex physiological factors that can impair conception. Male reproductive variables analyzed include seminal fluid abnormalities, structural issues, and sperm irregularities such as azoospermia and oligospermia, alongside functional complications like retrograde ejaculation and erectile dysfunction. Female reproductive factors focus heavily on ovulatory disorders, including polycystic ovary syndrome (PCOS) and premature ovarian failure, as well as structural and anatomical barriers like fallopian tube occlusion, cervical mucus abnormalities, and endometriosis. The text also thoroughly investigates the etiology of recurrent pregnancy loss, emphasizing chromosomal anomalies, uterine malformations, endocrine disruptions, environmental toxins, and immunologic conditions such as systemic lupus erythematosus (SLE). For clinical evaluation, the chapter outlines a systematic diagnostic approach for both partners, covering semen analysis, basal body temperature tracking, endocrine assays, ultrasonography, and hysterosalpingograms. Furthermore, it delves into diverse therapeutic interventions, ranging from pharmacological ovulation induction using medications like clomiphene citrate and gonadotropins to advanced assisted reproductive technologies (ART) such as in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and intracytoplasmic sperm injection (ICSI). The profound psychological impact of fertility struggles is addressed extensively, highlighting the emotional toll of grief, isolation, financial strain, and relationship stress. It guides healthcare professionals on therapeutic communication, coping strategies, and the application of the nursing process to support emotional well-being. Finally, the material explores alternative family-building options and outcomes, including therapeutic donor insemination, the use of donor oocytes, surrogate parenting, and adoption, equipping students with a holistic framework for supporting patients navigating the complex journey of family planning and reproductive medicine.