Need for the study



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

| | | |

|1 |NAME OF THE CANDIDATE AND ADDRESS |Ms VINU XAVIER, |

| | |D/O Mr. XAVIER VARGHESE , |

| | |MYLATTU HOUSE,VELLORA ( P.O), |

| | |EADYOLIL M.M BAZAR ( Via), |

| | |KANNUR (DIST) – 670306. |

| | | |

|2 |NAME OF THE INSTITUTION |AMBIGARA CHOWDAIAH COLLEGE OF NURSING,CHOKKANAHALLI, JAKKUR POST, HEGDE |

| | |NAGAR, BANGALORE-64 |

| | | |

|3 |COURSE OF STUDY AND SUBJECT |1ST YEAR M. Sc. NURSING |

| | |OBSTETRICS AND GYNAECOLOGICAL NURSING |

| | |DISSERTATION PROTOCOL |

|4 | |15.06.2011 |

| |DATE OF ADMISSION TO COURSE | |

| | | |

|5 |TITLE OF THE TOPIC |TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE |

| | |REGARDING PRIMARY INFERTILITY AMONG COUPLES. |

| | | |

6. BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION:

"A strong positive mental attitude will create more miracles than any wonder drug."

(PatriciaNeal).

Infertility is one of the most prevalent health disorders in young adults. As more women choose to delay childbearing, increasing numbers of them face age-related fertility problems. An increasing number of couples require medical assistance to achieve a pregnancy.1

Reproductive Disorders (RD), manifested by the biological inability to conceive (primary sterility) or inability to carry a pregnancy to full-term (infertility), affects 10-15% of reproductive-aged couples. The genetic etiology of RD is represented, in the majority of cases, by the chromosomal abnormalities.4

Infertility is defined as failure to conceive after one year of regular intercourse without contraception. Inability to conceive when desired can result from a defect at any of the stages. About one in every eight couples is infertile.Of all cases of infertility, 35% may be attributed to the male and 55% to the female; the remaining10% is undetermined.2

Definitions of infertility differ, with demographers tending to define infertility as childlessness in a population of women of reproductive age, while the epidemiological definition is based on "trying for" or "time to" a pregnancy, generally in a population of women exposed to a probability of conception. 3

World Health Organization define that a woman under 35 has not conceived after 12 months of contraceptive-free intercourse. Twelve months is the lower reference limit for Time to Pregnancy (TTP) by the Couples with primary infertility have never been able to conceive.4

Infertility may be primary or secondary. Primary infertility is when no pregnancy has ever occurred. Secondary infertility is when there have been one or more pregnancies but a further pregnancy has proved impossible. It has been estimated that the chances of conception for a given couple having regular sexual intercourse without any contraception are 80% and 90% after 12 months and 18 months respectively. It is therefore usual to begin investigations after one year. 5

Primary infertility is here defined as never having conceived before, secondary infertility as infertility subsequent to having conceived at least once. 6

One third of infertility cases are due to anatomical abnormalities of the female reproductive tract: endometrial polyps (33%), bilateral tubal blockage (12%), hydrosalpinx (7%), sub-mucosal fibroids (3%) and pelvic endometriosis. These may need surgical correction which could restore fertility. 7

Infertility affects about 7% of all men. The etiology of impaired sperm production and function can be related to factors acting at pre-testicular, post-testicular or directly at the testicular level. Primary testicular failure accounts for about 75% of all male factor infertility. Genetic factors can be identified in about 15% of cases.8

Women older than 35 years may benefit from ovarian reserve testing of follicle-stimulating hormone and estradiol levels on day 3 of the menstrual cycle, the clomiphene citrate challenge test, or pelvic ultrasonography for antral follicle count to determine treatment options and the likelihood of success. Options for the treatment of male factor infertility include gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Unexplained infertility may be managed with ovulation induction, intrauterine insemination, or both. The overall likelihood of successful pregnancy with treatment is nearly 50 percent . 9

6.1 Need for the study

Primary infertility is as common and distressing a problem in India as in other parts of the world. Semen abnormalities (22.4%), anovulation (17.2%), ovarian failure (8.8%), hyperprolactinemia (8.4%), and tubal disease (7.2%) are common causes of infertility. The pattern of infertility in India is the same as in other parts of the world, except that infertile couples report late for evaluation.

The world health organization estimates that 60 to 80 million couples world wide currently suffer from infertility. Infertility varies across regions of the world and is estimated to affect 8 to 12% of couples worldwide6

.Total infertility is divided into primary and secondary infertility. WHO, defines primary infertility as “Inability to conceive with in two years of exposure to pregnancy {i.e. sexually active non-contraception and non-lactating) among women 15 to 49 yrs old10.

Among Indian women reporting Primary infertility and PID, STI Prevalence was high. The WHO estimates the over all prevalence of Primary infertility in India to be between 3.9 and 16.8%. Estimates of infertility vary widely among Indian states from 3.7% in Uttar Pradesh, Himachal Pradesh and Maharashtra to 5% in Andrapradesh and 15% in kashmir. 11

Obese women have a higher prevalence of infertility compared with their lean counterparts. The majority of women with an ovulatory disorder contributing to their infertility have polycystic ovary syndrome (PCOS) and a significant proportion of women with PCOS are obese. Ovulation disorders and obesity-associated infertility represent a group of infertile couples that are relatively simple to treat.Maternal morbidity, mortality and fetal anomalies are increased with obesity and the success of assisted reproductive technology (ART) treatments is significantly reduced for obese women12.

Apart from medical and social implications of infertility, the problem of unfruitful marriages is of paramount importance in the context of state interests. Their primary activities should include the pre-conception assessment of the health status in pregnancy-planning couples, prophylaxis and treatment of possible diseases that are likely to have negative influence on the health of the future child.

Infertile women have significantly higher level of depressive symptoms and twice the prevalence of depressive symptoms relate to fertile women.

In the report a patient who suffered from secondary amenorrhea for 6 years and primary infertility for 2 years due to pituitary atrophy was successfully cured with Chinese herbs. After orally administered Chinese herbs for 1 month, the patient menstruated once and became pregnant later.

All women treated for infertility want to create a full family. They have problems in coping with emotional liability during treatment and a sense of fear and failure. Understanding the psychological mechanisms observed in patients treated for infertility might help to diagnose the causes of their problems with facing the new, extremely difficult situation13.

A study was conducted to correlate and prevalence of primary infertility among young women in My sore, India. Among 897 sexually active women, aged 15-30 yr, for a study investigating the relationship of bacterial vaginosis and acquisition of herpes simplex virus type-2 (HSV-2) infection. A secondary data analysis of the baseline data was undertaken. Primary infertility was defined as having been married for longer than two years, not using contraception and without a child. Logistic regression was used to examine factors associated with primary infertility. Results revealed that the mean age of the women was 25.9 yr (range: 16-30 yr) and the prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. The main factor associated with primary infertility was HSV-2 seropositivity (adjusted odds ratio: 3.41; CI: 1.86, 6.26). The estimated prevalence of primary infertility among women in the study was within the range reported by the WHO and similar to other estimates from India. Further research is needed in primary infertility14.

The researcher keeping above view points in mind and get interested in conducting structured teaching programme on knowledge regarding Primary Infertility among couples.

6.2 REVIEW OF LITERATURE

“Review of Literature is the reading and organizing of previously written materials relevant to the specific problems to be investigated; frame work and methods appropriate to perform the study”.

(Polit D.F and B.P Hungler)

The purpose of review of literature is to obtain comprehensive knowledge and indepth information about Primary Infertility among couples.

A prevalence survey was conducted in the district of Colombo, Sri Lanka to assess the psychological well-being and its correlates among women with primary infertility. A total of 177 women with primary infertility were compared with 177 fertile women matched for age and duration of marriage to identify differences in the psychological well-being between the two groups. Results revealed that Women with primary infertility reported more distress as compared to fertile women15.

A retrospective study was conducted regarding Chromosomal evaluation in couples with reproductive disorders, 266 couples with Reproductive Disorders were participated. Among them 80 (30.07%) with primary sterility (ST), 149 (56.01%) with Recurrent Spontaneous Abortions (RSA) and 37 (13.90%) with Stillborn Children (SC). A GTG-banded karyotype was performed on both partners of each couple. The results of the study underlined the major etiologic role of chromosomal abnormalities in Reproductive Disorders and the importance of chromosomal analysis for the etiologic diagnosis and genetic counseling of these patients16.

A meta-analysis of randomized trials examined metformin versus clomiphene treatment for non-obese women with anovulatory infertility related to PCOS. A result shows no significant difference in effectiveness of metformin versus clomiphene as ovulation induction agents for non-obese women with anovulatory PCOS. Metformin and clomiphene are both suitable options for first-line treatment. Primary outcomes were clinical pregnancy and live birth17.

A study was conducted to find the distribution of causes of infertility in couples referred to primary infertility clinics,Out of the 2515 couples identified, Primary infertility accounted for 65% of cases. Causes of infertility were male factor (45%), oligo-ovulation disorders (37%), and tubal damage (18%). Infertility factors were identified in the woman alone in 30.6% of cases and the man alone in 29.2%. Two combined infertility factors were found in 18% of patients, and three combined factors in 0.5%. The rate of unexplained infertility (which probably Includes non-tubal endometriosis) was 20.7%. The results show that as male factor accounts for almost half of all cases of infertility in couples, sperm analysis is mandatory before any treatment 18.

A descriptive observational study was conducted to evaluate the socio demographic characteristics and to find out the causes of infertility among the couple attending Out patient department of infertility unit. Out of 3184 patients, primary infertility was present in 1971(61.90%) and secondary infertility in 1213(38%) cases. Results revealed that a positive male factor problem alone was found in 13% couples, female factors in 71.46% couples and unexplained infertility in 15.47% couples. Among the male factor Oligozoospermia (33.33%) was the most common cause of male infertility. Anovulation (52.16%) was the most common cause of female infertility and major cause of anovulation was Polycystic ovary syndrome (PCOS) (29.90%). Fibroid

uterus, Bilateral tubal block and Pelvic inflammatory disease (PID) were significantly (p ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download